Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public.

Graphical abstract

中文翻译：

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因果关系主张中的流行病学原理：重复性头部撞击 (RHI) 和慢性创伤性脑病 (CTE) 的调查

确定重复性头部撞击（RHI）是否导致慢性创伤性脑病（CTE）-神经病理改变（NC）的发展以及病理改变是否导致临床综合征是全球运动医学界相当感兴趣的话题。 2022 年，发表了一篇文章，使用 Bradford Hill 标准来评估 RHI 导致 CTE 的说法。该出版物引起了国际媒体的关注，并被宣传为因果关系已成立的明确证据。我们的对立点根据所提出的主张以及用于发展这些主张的科学文献对已发表的文章进行了评估。我们的结论是，所提供的证据并不能证明因果关系的主张。我们讨论了现代流行病学中如何概念化原因，并强调当前暴露（RHI）和结果（CTE）的定义和测量中的缺陷。我们讨论了在最初的评论中用作证据的布拉德福德希尔论点，并得出结论认为因果关系的断言已经确立还为时过早。科学界成员必须谨慎做出因果断言，直到所提议的暴露和结果得到明确定义和一致测量，并且适当设计的研究结果已经发表。评估和反思研究质量是向公众提供准确的循证信息的关键一步。

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