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Getting Risk Right: Understanding the Science of Elusive Health Risks
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? What role does the HPV virus play in the development of cervical cancer, and is the HPV vaccine safe? In four detailed case studies, Geoffrey C. Kabat shows how science works... and sometimes doesn't, and what distinguishes these two very different outcomes. 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.
Kabat's goal in "Getting Risk Right "is to enable the general reader to 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 shows us why certain risks are worth worrying about, while others are not. Attempts to explain anti-science attitudes often focus on irrational fears and beliefs and on the powerful role of business interests. While these factors matter, Kabat emphasizes the variable quality of research in contested areas of health risks and the professional, political, and methodological factors that can distort the research process. Drawing on recent work in the "meta-analysis" of biomedical research and on insights from leading thinkers including John Ioannides, Daniel Kahneman, and Cass Sunstein, this groundbreaking work 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. Kabat, a leading public health thinker, provides a much-needed antidote to what has been called "an epidemic of false claims."
Kabat's goal in "Getting Risk Right "is to enable the general reader to 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 shows us why certain risks are worth worrying about, while others are not. Attempts to explain anti-science attitudes often focus on irrational fears and beliefs and on the powerful role of business interests. While these factors matter, Kabat emphasizes the variable quality of research in contested areas of health risks and the professional, political, and methodological factors that can distort the research process. Drawing on recent work in the "meta-analysis" of biomedical research and on insights from leading thinkers including John Ioannides, Daniel Kahneman, and Cass Sunstein, this groundbreaking work 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. Kabat, a leading public health thinker, provides a much-needed antidote to what has been called "an epidemic of false claims."
- GenresScienceNonfiction
272 pages, Hardcover
First published November 22, 2016
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Displaying 1 - 9 of 9 reviews
May 2, 2018
Absolutely a must-read. If you’ve ever been frightened by news about the latest health scare (phthalates in mac n’ cheese!) or worried that the things around you might be silently killing you (is this plastic BPA free?!), this is a book for you. I especially recommend it to parents who lose sleep worrying about how to keep their babies safe from a seemingly constant onslaught of environmental dangers lurking around every corner.
This book is a particularly salient breath of fresh air in the post-truth Trump era. Cancer epidemiologist Geoffrey Kabat showcases deep research in four case studies — the question of whether cell phones cause brain cancer (spoiler alert: they don’t), endocrine disrupters, HPV and cervical cancer, and the very strange case of Chinese herbs nephropathy — to demonstrate that, yes, there is still such a thing as facts, and through them we can arrive as near as possible to the truth.
By the end, the reader walks away reassured that the only dangerous toxins we need worry about reside in a media environment that hypes new studies for ratings and fails to put research findings into context for an over-anxious public.
This book is a particularly salient breath of fresh air in the post-truth Trump era. Cancer epidemiologist Geoffrey Kabat showcases deep research in four case studies — the question of whether cell phones cause brain cancer (spoiler alert: they don’t), endocrine disrupters, HPV and cervical cancer, and the very strange case of Chinese herbs nephropathy — to demonstrate that, yes, there is still such a thing as facts, and through them we can arrive as near as possible to the truth.
By the end, the reader walks away reassured that the only dangerous toxins we need worry about reside in a media environment that hypes new studies for ratings and fails to put research findings into context for an over-anxious public.
June 13, 2017
Kabat takes a sobering and sometimes stern look at many of the accepted scientific truths that have seeped, and in some cases, cemented into popular belief over the last ten to twenty years. He measures them up against the hard scientific data, accumulated over the years, arriving at some compelling and worrying results, that show how often the results have been blatantly bent, distorted and repurposed for cynical and often damaging means.
As well as citing the well known example of Andrew Wakefield’s devastatingly incompetent paper back in 1998, which claimed inaccurate links between MMR and autism, the legacy of which still wreaks havoc around the world today, he delves into the archives and picks out the origins of many other sources of mis-information elsewhere.
It was interesting to read about the various studies on mobile phone use. He talks about the Interphone study (a huge study that took in 13 different countries), that took place around the turn of the 21st Century, which showed the lack of evidence supporting brain cancers, but he then shows, how the less robust Hardell study, confined to Sweden, and showing more dubious foundations, has gained much momentum and been taken out of context, distorted by mainstream outlets and presented as something more genuine and influential than it should be, leading to all sorts of mis-information that largely continues today. Basically he tells us as there has been no increase in brain cancer in the US within twenty years of popular mobile phone use, this is significant, especially as there was a huge increase in lung cancer in the same time frame after increased cigarette consumption after WWI.
BPA is also brought under the microscope, in particular the idea of decreasing sperm count levels. He asserts that in toxicology, “where the dose makes the poison.” A study found, “Although most U.S. residents are exposed, actual exposures are very low-more than 99% of ingested BPA is efficiently metabolised and excreted. And this is true even in new borns. Crucially, these studies measured both free and bound BPA-only the free compound can have biological effects.” He quotes from Harry Fisch, “Far from being a worldwide and well-proved phenomenon, declines in semen quality are, at best, a highly local phenomenon with an unknown cause.” There is also some evidence to show actual increase in sperm count in some places.
He explores the many problems that can come with natural remedies too, citing many serious kidney cases which emerged from a diet club in Belgium, and how that linked with the mysterious Balkan endemic nephropathy, he ties this to other herbal cases in the US, exposing the following, chilling deception, “Many consumers tend to assume that, because these products are “natural” and are advertised and marketed legally, they must be safe, and that the claims of beneficial effects must have some basis. The reality is quite different. In fact owing to the growing clout of the dietary and herbal supplements industry, in 1994 Congress had passed the Dietary Supplement Health and Education Act (DSHEA), By defining herbal supplements and botanicals as “dietary supplements,” DSHEA exempted them from the more rigorous standards used by the FDA in regulating prescription and over the counter drugs and medical devices, essentially leaving it up to the industry to regulate itself.”
Kabat also discusses the huge progress made in treating cervical cancer. Although there are over 100 strains of HPV, thanks to ongoing research, they have managed to single out HPV-16 and HPV-18 as the primary causes of cervical cancer and steps have been taken in order to create vaccines to protect future generations from developing them.
This book follows in the footsteps of the likes of Goldacre’s “Bad Science”, Blaser’s “Missing Microbes” and Wolfe’s “The Viral Storm” in that it’s a welcome addition to the popular science cannon. Although not quite as accessible or consistent as these books, I'd say that overall this was a highly reasoned and well-argued piece of scientific writing that brings some much needed clear thinking and straight talking to some seriously murky and misleading myths that stubbornly persist in so much of the mainstream media and popular culture.
As well as citing the well known example of Andrew Wakefield’s devastatingly incompetent paper back in 1998, which claimed inaccurate links between MMR and autism, the legacy of which still wreaks havoc around the world today, he delves into the archives and picks out the origins of many other sources of mis-information elsewhere.
It was interesting to read about the various studies on mobile phone use. He talks about the Interphone study (a huge study that took in 13 different countries), that took place around the turn of the 21st Century, which showed the lack of evidence supporting brain cancers, but he then shows, how the less robust Hardell study, confined to Sweden, and showing more dubious foundations, has gained much momentum and been taken out of context, distorted by mainstream outlets and presented as something more genuine and influential than it should be, leading to all sorts of mis-information that largely continues today. Basically he tells us as there has been no increase in brain cancer in the US within twenty years of popular mobile phone use, this is significant, especially as there was a huge increase in lung cancer in the same time frame after increased cigarette consumption after WWI.
BPA is also brought under the microscope, in particular the idea of decreasing sperm count levels. He asserts that in toxicology, “where the dose makes the poison.” A study found, “Although most U.S. residents are exposed, actual exposures are very low-more than 99% of ingested BPA is efficiently metabolised and excreted. And this is true even in new borns. Crucially, these studies measured both free and bound BPA-only the free compound can have biological effects.” He quotes from Harry Fisch, “Far from being a worldwide and well-proved phenomenon, declines in semen quality are, at best, a highly local phenomenon with an unknown cause.” There is also some evidence to show actual increase in sperm count in some places.
He explores the many problems that can come with natural remedies too, citing many serious kidney cases which emerged from a diet club in Belgium, and how that linked with the mysterious Balkan endemic nephropathy, he ties this to other herbal cases in the US, exposing the following, chilling deception, “Many consumers tend to assume that, because these products are “natural” and are advertised and marketed legally, they must be safe, and that the claims of beneficial effects must have some basis. The reality is quite different. In fact owing to the growing clout of the dietary and herbal supplements industry, in 1994 Congress had passed the Dietary Supplement Health and Education Act (DSHEA), By defining herbal supplements and botanicals as “dietary supplements,” DSHEA exempted them from the more rigorous standards used by the FDA in regulating prescription and over the counter drugs and medical devices, essentially leaving it up to the industry to regulate itself.”
Kabat also discusses the huge progress made in treating cervical cancer. Although there are over 100 strains of HPV, thanks to ongoing research, they have managed to single out HPV-16 and HPV-18 as the primary causes of cervical cancer and steps have been taken in order to create vaccines to protect future generations from developing them.
This book follows in the footsteps of the likes of Goldacre’s “Bad Science”, Blaser’s “Missing Microbes” and Wolfe’s “The Viral Storm” in that it’s a welcome addition to the popular science cannon. Although not quite as accessible or consistent as these books, I'd say that overall this was a highly reasoned and well-argued piece of scientific writing that brings some much needed clear thinking and straight talking to some seriously murky and misleading myths that stubbornly persist in so much of the mainstream media and popular culture.
March 28, 2017
As a book proposal, this had promise. As a book it fell short. I was never sure who the audience was. Fellow academics? Health sciences students? The general public? It was never clear as some pages felt like reading a textbook, some were in the style of an academic paper and yet others tried to be ready for the ordinary reader. There wasn't much content there, and it look a long time to get there despite being under 200 pages. I did learn a few things along the way but I can't say I recommend this one. Would have been a good magazine article.
August 30, 2017
interestingly, this contains a chapter on aristolachic acid nephropathy similar to one in /Get Well Soon: History's Worst Plagues/. basic thrust of this book: don't take popular media reports of health risks as truth; go back to the original studies and see what they really said. and at that, evaluate the quality of the studies and whether they've been replicated, and see whether equally large studies have shown different results.
September 25, 2017
Many of use are bewildered on occasion by the reports of medical research on various health risks and dangers. If the flurry of claims and counter-claims bothers you, and you wonder how science could have gotten this way, this is a very enlightening book. Written by a highly-regarded and experienced epidemiologist, it lays out the basic principles behind the scientific approach to health and medicine and then presents four examples of major scientific investigations regarding health risks. The first two cases are highly-publicized areas where Kabat contends that emotion, bias, and political issues steered research in a particular direction that was aimed at confirming pre-conceived notions. The second two are examples of major research efforts that followed the evidence and discovered and proved out serious health risks that were leading to thousands of cancer deaths annually.
This is a great book that manages to make a scientific subject accessible for a non-technical audience and is an enjoyable and fun read to boot.
This is a great book that manages to make a scientific subject accessible for a non-technical audience and is an enjoyable and fun read to boot.
August 26, 2020
A good companion piece to Aaron Wildavsky's "But Is It True". The book gives academic and intensive discriptions of the issues behind stdies and metastudies, in a clear, but not simple manner. Exploring several reasonably recent moral panics (BPA, Cell PHones), it goes beyond disproving them to actually show whay the science debate occured, and what falacies contributed to them. The value is not the science, but (like Wildavky and Alar) understanding why te previous moral/health panic occured, and understanding how to avoid the next one.
February 10, 2026
Stop worrying about some environmental 'risks'.
September 28, 2020
[Imported automatically from my blog. Some formatting there may not have translated here.]
Another pick obtained for me via the Interlibrary Loan folks at the University Near Here. Thanks, folks!
I've been interested for a while about the general topic of risk, and how it might best be regulated in a free society. I'm still in the weeds, but maybe if I keep reading…
The author, Geoffrey Kabat, is an epidemiologist at the Albert Einstein College of Medicine; he's deep in the field of quantifying health risks. This book outlines the pitfalls and biases that researchers investigating causes of disease can fall prey to. And the realities of funding and publication pressures on researchers can, and does, incentivize a lot of bad, misleading, and unreproducible results. (For more on that topic, see the recent Wired article about John Arnold.) The discussion here is technical and valuable.
Kabat then turns to four recent case studies, two bad, two good. The bad: efforts to show that cell phone usage causes brain cancer, and the notion of "endocrine disruptors" in the environment. Both areas were sensationalized, and wasted a lot of funding that could have been spent on more productive areas.
The good: research into dangerous "Chinese herbal supplements" containing aristolochic acid; and how varieties of human papillomavirus (HPV) can result in various cancers, mostly cervical. These are heroic stories, as the scientists involved i-dotted and t-crossed their studies in order to tease out valid results, exposing disease processes that can take decades to actually kill you.
Kabat's prose is unfortunately wooden and to-be-sure mannered, and he's mind-numbingly diligent about dropping names and professional affiliations of the researchers he discusses. Fine, but that gets in the way of the narrative. (He's no Daniel Kahneman, sorry.) But, even given that, the book is a good discussion on how to do research right, and also wrong.
He (also unfortunately) doesn't get close to my main concern: once you've identified and quantified a risk, what's the proper policy response, especially given that people have widely varying tolerance for risky behaviors?
Also, a pet peeve: he refers to "socioeconomic inequality" (p. 179) when he almost certainly means "poverty".
April 14, 2017
I had high hopes for this book, but it disappointed. There were a lot of good things about the book. It was obviously well researched and the author did an excellent job of citing the research. He also did a decent job of summarizing the research in a way that people without a scientific background could understand and of presenting himself as an expert on the topic of health research, It is clear, he knows what he is talking about. However, while he argues about bias in other people, he did a very poor job of hiding his own biases - which in a way is good, since it goes you an idea of how to evaluate what was presented in the book. For instance, Kabat included personal opinions in the definitions of terms found in the glossary at the end of the book. To me, this is just unacceptable. He also contradicted himself on a couple of occasions. For instance, while writing about the research on cell phones, he pointed to several animal studies which showed no cause for concern as part of the overall picture of the resource on the topic. Then he started talking about endocrine disrupting chemicals, and he claimed animal studies should not be considered because they can't transfer to humans. As someone who's studied public health, I can evaluate when animal studies are good and when they're not and I'm also aware of the limitations of applying them to human even when they are good. But he never made it clear to the readers why he arguing that these studies shouldn't be considered in the discussion of endocrine disruptors, but should in cell phone studies (it is clear from reading the book, that he agrees with the results of the cell phone studies and not the endocrine disruptor studies). Also, he argues against all chemical/environmental endocrine disruptors while discussing studies only of BPA with some references to DES also made. Again, he does not make it clear why he thinks that studies of BPA only rule out any chance that hundreds of other chemicals could impact human health. Finally, my biggest problem with the book is that although he correctly points out the problems associated with trying to prove the a certain chemical causes health concerns at constant low level of exposure (trying to determine exposure levels, interactions with other chemicals, etc.). So, a lot of chemical have not been proven to cause problems in humans. He then takes the stand that this means exposure to the chemicals is safe. It is especially bizarre that he does this given that he includes an example of a relative rare cancer caused in one part of the world due to a weed being mixed in with grain used to make bread and how the cause of the cancer went undetected for years. He uses the example to show how difficult it is to come up with answers and prove causation. By his logic, he would have been saying the bread was safe right up until the end of the story, but it wasn't safe- it just hadn't yet been proven to be the cause of the cancers. It was a great example to include in the book, but it made his conclusions in other parts of the book look completely suspect.
Displaying 1 - 9 of 9 reviews