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Getting Risk Right: Understanding the Science of Elusive Health Risks, by Geoffrey C. Kabat
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Do cell phones cause brain cancer? Does BPA threaten our health? How safe are certain dietary supplements, especially those containing exotic herbs or small amounts of toxic substances? Is the HPV vaccine safe? We depend on science and medicine as never before, yet there is widespread misinformation and confusion, amplified by the media, regarding what influences our health. In Getting Risk Right, Geoffrey C. Kabat shows how science works―and sometimes doesn't―and what separates these two very different outcomes.
Kabat seeks to help us distinguish between claims that are supported by solid science and those that are the result of poorly designed or misinterpreted studies. By exploring different examples, he explains why certain risks are worth worrying about, while others are not. He emphasizes the variable quality of research in contested areas of health risks, as well as the professional, political, and methodological factors that can distort the research process. Drawing on recent systematic critiques of biomedical research and on insights from behavioral psychology, Getting Risk Right examines factors both internal and external to the science that can influence what results get attention and how questionable results can be used to support a particular narrative concerning an alleged public health threat. In this book, Kabat provides a much-needed antidote to what has been called "an epidemic of false claims."
- Sales Rank: #62432 in Books
- Published on: 2016-11-22
- Original language: English
- Dimensions: 9.25" h x 6.25" w x .50" l, .0 pounds
- Binding: Hardcover
- 272 pages
Review
Geoffrey Kabat's vital, wide-ranging book cannot have arrived at a more fortuitous time. As individuals and societies, we are constantly asked to gauge risks―and we often do so hastily or irrationally, with grave consequences. In Getting Risk Right, Kabat provides a crucial framework to think about risks, biases, and judgment. Everyone should read his analysis―at once clear-eyed, thoughtful, and beautifully written―to understand the nature of risk. I cannot overstate the importance of this book.
(Siddhartha Mukherjee, author of The Emperor of All Maladies)
Some risks are real, while others are much feared and speculated about, but of no portent. This important book by Geoffrey Kabat shows how the science of studying risks can lead to major discoveries that can improve the lives of millions by identifying and validating risks that do matter; or can ruin lives by propagating spurious, nonexistent risks in the public mind and in the scientific literature. Getting Risk Right carefully surveys a scientific field that is often the topic of hot debate and offers a balanced presentation. It is a fascinating read.
(John Ioannidis, professor of medicine and health research and policy, Stanford University)
Zika, Ebola, vaccines, dioxin, radon, black mold, environmental toxins. The media constantly bombards us with stories about unseen agents causing insidious harms. In Getting Risk Right, Geoffrey Kabat uses four case studies―BPA, cell phones, the HPV vaccine, and dietary supplements―to teach us not only whether these products are harmful but also how to grade information. Using Kabat's method, readers will be able to determine whether the next media-infused risk is a real one. Filled with cartoons, case histories, literary references, and fascinating asides, Getting Risk Right is the last book you will ever need to read on this subject.
(Paul A. Offit, author of Autism's False Prophets)
Geoffrey Kabat's writing, as usual, is phenomenally clear and expressive. His logical cadences are both airtight and a pleasure to read. His insights into the workings and mis-workings of science, the sociology of science, and the interplay of personalities and organizations are penetrating and precise, and above all original.
(Steven D. Stellman, professor of clinical epidemiology, Columbia University Mailman School of Public Health)
What matters most? How can we use scientific findings intelligently to set our public priorities? Through engaging anecdotes, and a clear-eyed analysis of the strengths and weaknesses of scientific work, Getting Risk Right helps us answer those questions. Perhaps more importantly, Dr. Kabat enhances our understanding of how science leads to action, and how we can better use science to inform a more rational and productive public agenda.
(Sandro Galea, Dean, Boston University School of Public Health)
An important study that teaches how to decipher science and medical news.
(Library Journal)
It is not easy feat to take complex issues and make them both understandable, easily readable and interesting, but Kabat does just that in Getting Risk Right. For people who are trying to sort through the deluge of conflicting information that we see every day, this book is a must.
(Josh Bloom American Council on Science and Health)
Kabat writes clearly, but his discussions of association, causality and toxicology are, at times, a bit technical for the general reader. More intriguing ― and more unique, in my experience ― is his insider's dissection of the psychology of how environmental studies are funded, reported and interpreted by their authors and by various audiences.
(Washington Post)
Excellent.... A potent antidote to the toxic misinformation polluting our public health discourse.
(Reason)
About the Author
Geoffrey C. Kabat, a cancer epidemiologist at the Albert Einstein College of Medicine, has studied a wide range of lifestyle and environmental factors associated with cancer and other diseases. He is the author of Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology (2008) and writes a regular column for Forbes on the perception vs. the reality of health risks.
Most helpful customer reviews
2 of 2 people found the following review helpful.
Makes a valuable contribution on a difficult topic
By Robert E. Tarone
In an influential paper published in 2005 Dr. John Ioannidis concluded that most published research findings in the medical literature are false. His conclusion that most published findings are false has not been refuted, but neither has the knowledge of this dismal conclusion appeared to have had a beneficial effect on the way that studies in most areas of public health research are conducted, analyzed, interpreted, and reported, either to the scientific community in published journals or to the public in news reports. Empirical estimates have indicated that there may be as many as 20 false published findings for every true published result, and it has become clear that sorting out true causal relationships in the face of the high background rate of false-positive findings is a daunting task, not only for scientific and regulatory bodies, but even more so for the general public.
In “Getting Risk Right”, Geoffrey Kabat explores why it is so difficult for scientists to reach valid conclusions from their investigations, and provides some guidance to readers, both in the scientific community and the lay audience, as to how one can distinguish between a body of scientific evidence that is likely to reflect a true causal relationship and body of evidence that does not support a causal interpretation of a reported association (or correlation).
The first three chapters provide an excellent summary of the many pitfalls and biases that can lead even experienced researchers astray in the interpretation and reporting of their studies. Kabat also examines how the complex interaction between the scientific community and society at large (including the media, regulatory bodies, environmental advocacy groups, etc.) complicates the communication of potential health risks to the general public. This is particularly a problem for studies into possible environmental causes of chronic diseases, because of the extremely strong interest in the public regarding factors that might have a direct effect on the health and welfare of individuals.
Chapters four through seven present detailed case studies of four actual scientific investigations into the environmental causes of disease, two of which resulted in the establishment of firm causal conclusions and two of which, in spite of several decades of research, have only resulted in confusion and continued controversy over whether a causal association exists. Kabat relates these fascinating case studies in order to draw out important characteristics (both of the scientific studies and the way in which they are reported) that differentiate between a body of strong scientific evidence that demonstrates a causal relationship between an exposure and chronic disease risk and a weak body of evidence that may well keep a controversy alive, but holds little promise that continued research will lead to a resolution of the hypothesized exposure-disease association.
“Getting Risk Right” is an excellent book, which should be of interest not only to scientists and science journalists, but also to members of the public who want to increase their ability to make sense out of the frequently confusing, and often contradictory barrage of media reports about potential environmental health hazards. “Getting Risk Right” makes a valuable contribution on a difficult topic, and I highly recommend it to all readers with an interest in environmental health science.
14 of 16 people found the following review helpful.
in my theology there is always hope and redemption So I suggest that Louis study the science describing the lack of effects of w
By Robert K. Adair
I was not sure if I should laugh or cry upon reading journalist Louis Slesin’s contemptuous review of epidemiologist Geoff Kabat’s book, “Getting Risk Right”. In that review, Slesin, whose science education ended with a master’s degree about forty years ago, assaults Kabat, a distinguished epidemiologist with a career that extends over much of that forty year period. Indeed, Geoff was immersed in science from childhood. His father, Elvin Kabat was a distinguished biologist and a member of the National Academy of Sciences.
Slesin especially criticizes Kabat’s Chapter 4, “Do Cell Phones Cause Brain Cancer?” which, answers that question with a strong negative. In that chapter, Kabat points out that the electromagnetic fields from cell phones are quite weak; too weak to generate biological activity through the forces generated by the electric fields acting on charged biological elements. However, weak high frequency fields can also affect biology through quantum effects, the interactions of photons with biological material. But Kabat showed that at the frequencies in question, the photon energies are too small to generate biological effects. Since the possibility of deleterious effects of such weak microwaves on health have been at the center of Slesin’s journal, Microwave News, that conclusion, which Slesin -- no scientist! -- does not understand, largely vitiates his life’s work. Hence his strong objections to Kabat’s book.
Slesin then refers to reports in the biological scientific literature which he argues contradicts the conclusion of Kabat and others, that weak microwave fields cannot effect biology. The remarkable paper by John Ioannidis, “Why Most Research Findings are False” published about ten years ago and was almost completely accepted, explained the few aberrant results purporting to show biological effects of the weak electromagnetic fields of interest. The results that Slesin refers to, are simply false.
So Louis Slesin is completely wrong -- and has always been wrong. However, in my theology there is always hope and redemption So I suggest that Louis study the science describing the lack of effects of weak cell-phone fields on living systems -- and he can start by rereading Chapter 4 of Geoff Kabat’s fine book.
Robert K. Adair
1 of 1 people found the following review helpful.
are doing a poor job of assessing risk
By Josh Bloom
In precisely 13 words—the beginning of the preface—the reader will have little about doubt the message that follows in a new, intriguing, and badly-needed book, "Getting Risk Right" (Columbia University Press) by Dr. Geoffrey Kabat, a Cancer Epidemiologist at the Albert Einstein College of Medicine in New York.
'WHY DO THINGS THAT ARE UNLIKELY TO HARM US GET THE MOST ATTENTION?'
Only the details need follow, and because Kabat chooses these details wisely, he makes his point quite clearly—that Americans, often through no fault of their own, are doing a poor job of assessing risk. We overreact to miniscule or theoretical risks, under react to real ones, and end up making poor decisions as a result.
The timing could hardly be better, since intentional confusion about fear is an increasingly powerful, calculated tool used to sway consumer purchasing habits and behaviors and solicit donations to non-government organizations, as well as by officials at government agencies to increase their job security and power.
It could be argued that we are being bombarded like never before by incessant propaganda in the form of false or misinterpreted studies and intentional slights of hand, leaving ordinary people with little choice other than to throw up their hands and simply give up trying to figure out what is right and what is wrong. Kabat's book will give them at least a fighting chance to critically evaluate the conflicting information that they are getting.
Dr. Kabat carefully selects examples of poor assessment of relative risk in a way such that any reader would gain an understanding of how wrong we're getting it and why. His second chapter, "Splendors and Miseries of Associations" examines our very different responses when confronted with a theoretical or nonexistent risk as opposed to a very real one by comparing the different approaches elicited by comparing BPA, a ubiquitous component of plastic with the 2014 Ebola outbreak.
BPA can be detected in miniscule amounts in the urine of almost everyone in developed countries, since it has been used for 60 years in multiple products. However more than 99 percent of the chemical is rapidly metabolized and then eliminated in the urine so that it does not bioaccumulate.
"Is it possible that exposure to BPA poses some hazard to some people? Yes, we can never rule out the possibility of some effect. But, based on a large amount of accumulated scientific evidence, any adverse effect, if one exists, is likely to be very small."
Kabat then contrasts our fear of the chemical with that of the epidemic, where the cause and effect between the virus and illnesses were without doubt. The death rate from Ebola was 60 percent, and by the time the WHO declared the outbreak to be over, more than 11 thousand people had died. At one point, 40 percent of Americans were concerned about a major outbreak here, ignoring the fact that living conditions in West Africa— lack of proper medical care and infrastructure—were major contributors to the deaths, so the likelihood of a similar scenario developing in the US is slight. We overreacted to both, but for different reasons.
Kabat takes it a step further. The connection between BPA and human health effects is tenuous at best, while that of Ebola could not be more clear. Yet, neither is likely to do us much harm in the US. But something else is—flu, which causes tens of thousands of deaths per year, many of which could be avoided by an annual flu vaccine. Flu represents a case of a known, serious threat, yet people routinely fail to get the vaccine, while worrying about the tiny amount of BPA in food can liners.
Perhaps the most important aspect of the book is Kabat's comparison of two types of studies, observational and experimental. All studies are not equal. Far from it, although to most people they are indistinguishable. Observational studies are inferior by any measure. They involve collection of and analysis of previous data from unrelated studies, and are subject to multiple confounders (variables that add errors to a study), whereas experimental (prospective) studies are designed to examine a particular effect, and usually involve control groups as a comparator. Kabat clearly explains the difference, which will leave many readers wondering "why are these both called studies"?
Much of the misinformation we are exposed to is due to the Internet and poor or sensationalized headlines in the press. In the chapter "When Risk Goes Viral. Biases and Bandwagons" Kabat explains how a scientific paper, either or good and bad, triggers a series of events that ultimately results in a disconnect between the findings of the study and what the public will hear. After the following sequence: scientific literature, media reporting, regulatory recommendations, political agendas, and finally health narratives, we end up with information often bears no resemblance to what started as science.
"Media reporting of the results of scientific studies bearing on health risks exerts an influence in a class of its own."
This is no accident. Although there are many high quality studies on health, those that promote fear, especially by the use of alarmist, inaccurate headlines, get the attention. One notable example is the scare from the 1990's about electromagnetic fields (EMF), generated from power lines, which were thought to have a dramatic impact on human health. When news shows interviewed scientists about the science, it was all but certain that there would be a photo or film clip of scary looking high voltage transmission lines. What was often left unsaid was that electromagnetic fields weaken very quickly with distance from the source. Although the EMF scare has been dismissed by the scientific community, the scares persist two decades later.
In precisely 13 words—the beginning of the preface—the reader will have little about doubt the message that follows in a new, intriguing, and badly-needed book, "Getting Risk Right" (Columbia University Press) by Dr. Geoffrey Kabat, a Cancer Epidemiologist at the Albert Einstein College of Medicine in New York.
'WHY DO THINGS THAT ARE UNLIKELY TO HARM US GET THE MOST ATTENTION?'
Only the details need follow, and because Kabat chooses these details wisely, he makes his point quite clearly—that Americans, often through no fault of their own, are doing a poor job of assessing risk. We overreact to miniscule or theoretical risks, under react to real ones, and end up making poor decisions as a result.
The timing could hardly be better, since intentional confusion about fear is an increasingly powerful, calculated tool used to sway consumer purchasing habits and behaviors and solicit donations to non-government organizations, as well as by officials at government agencies to increase their job security and power.
It could be argued that we are being bombarded like never before by incessant propaganda in the form of false or misinterpreted studies and intentional slights of hand, leaving ordinary people with little choice other than to throw up their hands and simply give up trying to figure out what is right and what is wrong. Kabat's book will give them at least a fighting chance to critically evaluate the conflicting information that they are getting.
Dr. Kabat carefully selects examples of poor assessment of relative risk in a way such that any reader would gain an understanding of how wrong we're getting it and why. His second chapter, "Splendors and Miseries of Associations" examines our very different responses when confronted with a theoretical or nonexistent risk as opposed to a very real one by comparing the different approaches elicited by comparing BPA, a ubiquitous component of plastic with the 2014 Ebola outbreak.
BPA can be detected in miniscule amounts in the urine of almost everyone in developed countries, since it has been used for 60 years in multiple products. However more than 99 percent of the chemical is rapidly metabolized and then eliminated in the urine so that it does not bioaccumulate.
"Is it possible that exposure to BPA poses some hazard to some people? Yes, we can never rule out the possibility of some effect. But, based on a large amount of accumulated scientific evidence, any adverse effect, if one exists, is likely to be very small."
Kabat then contrasts our fear of the chemical with that of the epidemic, where the cause and effect between the virus and illnesses were without doubt. The death rate from Ebola was 60 percent, and by the time the WHO declared the outbreak to be over, more than 11 thousand people had died. At one point, 40 percent of Americans were concerned about a major outbreak here, ignoring the fact that living conditions in West Africa— lack of proper medical care and infrastructure—were major contributors to the deaths, so the likelihood of a similar scenario developing in the US is slight. We overreacted to both, but for different reasons.
Kabat takes it a step further. The connection between BPA and human health effects is tenuous at best, while that of Ebola could not be more clear. Yet, neither is likely to do us much harm in the US. But something else is—flu, which causes tens of thousands of deaths per year, many of which could be avoided by an annual flu vaccine. Flu represents a case of a known, serious threat, yet people routinely fail to get the vaccine, while worrying about the tiny amount of BPA in food can liners.
Perhaps the most important aspect of the book is Kabat's comparison of two types of studies, observational and experimental. All studies are not equal. Far from it, although to most people they are indistinguishable. Observational studies are inferior by any measure. They involve collection of and analysis of previous data from unrelated studies, and are subject to multiple confounders (variables that add errors to a study), whereas experimental (prospective) studies are designed to examine a particular effect, and usually involve control groups as a comparator. Kabat clearly explains the difference, which will leave many readers wondering "why are these both called studies"?
Much of the misinformation we are exposed to is due to the Internet and poor or sensationalized headlines in the press. In the chapter "When Risk Goes Viral. Biases and Bandwagons" Kabat explains how a scientific paper, either or good and bad, triggers a series of events that ultimately results in a disconnect between the findings of the study and what the public will hear. After the following sequence: scientific literature, media reporting, regulatory recommendations, political agendas, and finally health narratives, we end up with information often bears no resemblance to what started as science.
"Media reporting of the results of scientific studies bearing on health risks exerts an influence in a class of its own."
This is no accident. Although there are many high quality studies on health, those that promote fear, especially by the use of alarmist, inaccurate headlines, get the attention. One notable example is the scare from the 1990's about electromagnetic fields (EMF), generated from power lines, which were thought to have a dramatic impact on human health. When news shows interviewed scientists about the science, it was all but certain that there would be a photo or film clip of scary looking high voltage transmission lines. What was often left unsaid was that electromagnetic fields weaken very quickly with distance from the source. Although the EMF scare has been dismissed by the scientific community, the scares persist two decades later.
In subsequent chapters, Kabat applies similar logic and reasoning to debunk other common, but unfounded fears, such as the cell phone-brain cancer link, the assault on our endocrine systems from everyday trace chemicals, and the pervasive, but entirely incorrect "natural equals safe" mindset. His criticism of dietary supplements, and the law that made them possible is clear, compelling, and includes that back story of how these supplements got a free pass, despite the fact that they are untested and unregulated drugs.
It is not easy feat to take complex issues and make them both understandable, easily readable and interesting, but Kabat does just that in "Getting Risk Right." For people who are trying to sort through the deluge of conflicting information that we see every day, this book is a must.
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