LinkedIn

Thursday, April 14, 2016

Risk Assessment Without Numbers

Adam Finkel recently sent me a Commentary from an advanced access publication (January 2016) of the Annals of Occupational Hygiene entitled “Hygiene Without Numbers” by Hans Kromhout.    Adam knows me and knows that I could not read such a piece an NOT comment.

I have never met and do not know Dr. Hans Kromhout, except by reputation, but I found his words to be right to the mark in his two pages of comments which I would be happy to forward to anyone requesting it of me at mjayjock@gmail.com.

Hans Kromhout described control banding as a "numberless intervention" and generally criticized its adequacy.  Indeed, I have always been frankly wary of control banding, which in my opinion, uses available and typically quite limited data to takes educated guesses at the ranges of toxicity to provide the level of needed control at various bands of exposure.  When combined with “exposure banding” one takes a similar banding estimate approach to the level of exposure that might be extant to get some notion of risk.   I CAN see this as the FIRST steps in a process aimed at understanding and controlling risk for a large number of chemicals but, like Dr. Kromhout, I do not see it as the end game.  There is simply too much uncertainty related to underestimation or, on the other side, overestimation of risk and both conditions are unacceptable for obvious reasons.

Everyone wants to “add value” to their organization and be “cost-effective”.  These are well-worn and, on their face, not unreasonable precepts enshrined in our psyche over at least the past 20-30 years especially in Corporate America.  Indeed, I believe that these personal/professional drivers have fed the rush to banding.   The bottom-line for me is that, according to my mother, there is no free lunch.  When one is committed to trying to understand the risk to human health from exposure to the vast majority of chemicals in commerce, we face an enormous short-fall in basic information related to both the toxicity and exposure associated with our interactions with these chemicals in a modern society.  I see banding as a response to the pressures that result from this uncomfortable situation.  As indicated above, I see it is a positive initial move but, I believe, in the majority of cases it does not reasonably or adequately assess the risk.

Risk assessment desperately needs data and the subsequent modeling of that data as the application of the scientific method to interpret that data and adequately estimate the level of risk.   That is, we need data on both the toxicity and exposure which should be accompanied by modeling these data to inform our confident knowledge of and decisions concerning the risk posed.   Like food and water, I believe that, freedom from unacceptable risk to chemicals should be considered to be a human need and its importance and provision should be recognized and addressed as such.

Spending the money to get the “numbers” will be much more expensive than proceeding with banding as the end game; however, it will be “cost-effective” relative to preventing unacceptable exposures and risk (or over-regulation).  This should be an important precept for any general society that truly values both its general economic health and the physical health of its citizens.



6 comments:

  1. Hi,

    I have great problems with some of the concepts behind risk assessment.


    Firstly, and fore-mostly, whilst we do have some information, albeit limited in most circumstances, from toxicological, epidemiological and mechanistic studies, about the consequences of exposures, we rarely have any information about the probability of exposure. Consequently, numbers are too often produced from thin air!

    Secondly, so what! Rather than make up numbers why don't we use conditional probabilities of the severity, and likelihood of injury given realistic scenarios so that we can determine what preventative and protective measures should be taken having regard to the social, legal and moral consequences of taking or not taking those actions.

    Just a thought!

    ReplyDelete
    Replies
    1. Hi Adrian,

      Even though the bands are not just made up - they are typically put together IMO with less than sufficient data. Using conditional probabilities is perhaps the best way to go but might be a hard sell.

      Delete
  2. There is often a need of a reasonably quick educated guess, we cannot always wait years and years for precise data. But no data at all, that makes no basis for guessing!!!

    ReplyDelete
  3. Hi Chrissy,

    Indeed, waiting is never a good idea. I just wanted to make the point that bands should not be the end game which, I am afraid, they are typically considered today.

    ReplyDelete
  4. Hiv disease for the last 3 years and had pain hard to eat and cough are nightmares,especially the first year At this stage, the immune system is severely weakened, and the risk of contracting opportunistic infections is much greater. However, not everyone with HIV will go on to develop AIDS. The earlier you receive treatment, the better your outcome will be.I started taking ARV to avoid early death but I had faith in God that i would be healed someday.As a Hiv patent we are advise to be taking antiretroviral treatments to reduce our chance of transmitting the virus to others , few weeks ago i came on search on the internet if i could get any information on Hiv treatment with herbal medicine, on my search i saw a testimony of someone who has been healed from Hiv her name was Achima Abelard and other Herpes Virus patent Tasha Moore also giving testimony about this same man,Called Dr Itua Herbal Center.I was moved by the testimony and i contacted him by his Email.drituaherbalcenter@gmail.com We chatted and he send me a bottle of herbal medicine I drank it as he instructed me to.After drinking it he ask me to go for a test that how i ended my suffering life of Hiv patent,I'm cured and free of Arv Pills.I'm forever grateful to him Drituaherbalcenter.Here his contact Number +2348149277967...He assure me he can cure the following disease..Hiv,Cancer,Herpes Virus,Lyme Disease,Epilepsy, ,Bladder Cancer,Colorectal Cancer,Breast Cancer,Kidney Cancer,Leukemia,Lung Cancer,Non Hodgkin Lymphoma,Skin Cancer,Lupus,Uterine Cancer,Prostate Cancer, fibromyalgia ,ALS,Hepatitis,Copd,Parkinson disease.Genetic disease,Fibrodysplasia disease,Fibrodysplasia Ossificans Progressiva,Fluoroquinolone Toxicity Syndrome,Liver/Kidney Inflammatory,Men/Woman infertility, bowel disease ,Huntington's disease ,Diabetes,Fibroid...

    ReplyDelete
  5. Chemicals used in industries gives me Leukemia Cancer and it's all started when I wanted to get off my job to get another job that when I got diagnose, at that very point I was so scared to die because it has infected my blood cells also I was prescribed drugs like Cyclophosphamide,Busulfan,Bosutinib,Cytarabine, Cytosar-U (Cytarabine),Dasatinib in all that was just to keep me waiting for my dying day. I got inspired by what I read from a lady called Tara Omar on blog spot on how Dr Itua cure her HIV/Aids then they were lettered below that says he can cure Cancer so I pick his contact on the testimony she wrote then I emailed Dr Itua hopefully he replied swiftly to my mail then I purchased his Herbal medicine also it was shipped to me here in Texas, I went to pick it at post office so he instructs me on how the treatment will take me three weeks to cure my Leukemia Disease, Joyfully I was cured by this Dr Itua Herbal Medicine.
    I will advise you too to give a try to Dr Itua Herbal Medicine with the following diseases that he can help you cure forever___Diabetes, Herpes,HIV/Aids, Bladder Cancer, Breast Cancer, Vaginal Cancer, Kidney Cancer, Lung Cancer, Skin Cancer, Uterine Cancer, Prostate Cancer, Colo_Rectal Cancer, Leukemia Cancer, Hepatitis, Brain Tumors, Love Spell, Infertility, Hpv. GoodLuck.
    Dr Itua Contact Information:::
    Email (drituaherbalcenter@gmai.com)
    WhatsApp-(+2348149277967)

    ReplyDelete