The Illusion of Certainty

Risk analysis and risk assessment have been with us long enough for the terms to sound familiar to most people. Standard fare for the nuclear power industry and the military for a half a century or more, risk assessment is now a routine aspect of environmental management, public health and individual medical decision making. There have been popular books on risk, and the current poker craze will likely spread risk concepts to an even wider (and younger) audience. Yet, despite all of this extensive and varied experience, we the analysts and practitioners have not done nearly enough to explain to the people who need to know what they need to know - especially the uncertainty inherent in risk estimates. There are many instances in which the failure to communicate risk information accurately or completely has had an important and material impact on decisions and actions. I have been involved in some of these, ranging from local plans for water management to national decisions about nuclear waste. I have seen first hand the effects of poorly done risk asse- ments and bad risk communication, and especially the way in which the uncertainly of risk estimates is handled (or mishandled). The con- quences of doing this wrong are high. It-s high time that we addressed this gap in understanding, and this book is an excellent and important step in doing so.

Erik Rifkin is the president of an environmental consulting firm that specializes in the characterization of ecological and human health risks from exposure to soil, water, air and sediments. His firm provides assistance and guidance to federal and state regulatory agencies and corporations regarding the nature and magnitude of environmental risks and potential remediation strategies. Dr. Rifkin's broad experience includes the communication of health risks and benefits to groups concerned with these issues. Edward J. Bouwer is Professor of Environmental Engineering at Johns Hopkins University in Baltimore, Maryland. He has extensive experience with water and soil pollution and treatment. His research provides guidance on defining and managing environmental risks and how to interpret human and ecological health risk data. Dr. Bouwer has served on several National Research Council committees that provide guidance on managing human and ecological risks to Congress, regulatory agencies, and the scientific community.

The Basics.- The Illusion of Certainty.- Cause and Effect vs. Risk Factors.- Reframing the Debate.- Assessing Human Health Risks from Environmental Contaminants.- The Sources of Uncertainty.- Case Studies.- VioxxTM and Heart Attacks.- Prostate Cancer Screening.- Elevated Cholesterol: A Primary Risk Factor for Heart Disease?.- Statins, Cholesterol, and Coronary Heart Disease.- Colorectal Cancer Screening.- Health Effects of Smoking.- Chlorination of Drinking Water and Health Risks.- Exposure to Residential Radon and the Risk of Lung Cancer.- Ecological Risk Assessment.- Asian Oysters in the Chesapeake Bay.- Chromium and Sediment Toxicity.- Perspectives.- The Physician's and Patient's Perspective.- Acceptable Health Benefits and Risks.