Index

A

Absolute risk (AR), 33-34, 80, 172-173, 175-177, 180, 213
Absolute risk reduction (ARR), 19, 22-25, 34, 75, 78, 80, 105, 107, 113, 175-177, 180, 213
Absolute risk vs. relative risk, 19-20
Acceptable environmental risks, 191-195
Acceptable health benefits, 190, 196-200, 213
Acceptable risk level, 9, 22, 27, 42-43, 75, 108, 189-190, 213
Acid Volatile Sulfides (AVS), 159
Adverse health effects, 37, 45, 62
Advertising, of drugs, 85-86, 184-185
AIDS, 16, 53, 63
AIDS RCTs, 35-36
Air contamination, 40, 44, 51, 189
Air emissions, 37, 40
Alpha radiation, 128
American Cancer Society, 105, 108, 197
American Medical Association, 198
Amphipods, 159
Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), 99
Animal experiments, 17
Animal toxicity studies, 56-57, 59, 67
Asbestos, 16-17
Asian oysters, 13, 141
Atherosclerosis, 83, 86, 213
Atorvastatin, see Lipitor™
Australia's Great Barrier Reef, 138
Average, statistical, see Mean, statistical

B

Baltimore Harbor sediments, 154, 156, 158-159, 161
Benzene, 45, 49, 51, 62
Biennial mammograms, 24
Biological control of weeds and flies, 136-137
Biomarker, 78, 214
Biopsies, 24, 26, 79-80
Bottled water, 124-125
Breast cancer, 15, 17, 19, 23, 178
British Doctors Study of smoking habits, 113, 115

C

California pulpmills, 37, 51, 62
Cancer risks, 5-6, 9-10, 12, 15-17, 23, 37, 40, 44-45, 49, 51, 58-59, 79, 122, 127-132, 176-177, 179, 196, 214
Cancer screening, 15, 23, 105-108, 186, 196
Carcinogenic air emissions, 51
Carcinogenic contaminants, 9, 16, 49, 58, 158
Carcinogenic effects, 8-9, 42, 59
Carcinogenic risk, 122-124, 128
Cardiovascular events, 73, 75
Cause and effect relationships, of events, 16-17, 53, 83, 110, 214
Cause and effect relationships vs. risk factors, 170-172
Celebrex™, 74
Celecoxib Long-term Arthritis Safety Study (CLASS), 74
Chemical movement reactions, 60-61
Chemical precipitation and reaction, 61
Chemical toxic properties, 46
Chesapeake Bay oysters, health of, 141-151
Chlorinated drinking water and health risks, 13, 117-125, 191
Chlorinated herbicides, 10
Chlorination, 122-124, 191, 214
Chloroacetic acid, 120
Chloroform, 49, 120
Cholesterol levels, elevated, 83-92, 184, 209-212
Cholesterol Risk Characterization Theaters (RCTs), 93
Chloroform, 51, 120
Chromium, 13, 153
Chromium and sediment toxicity, 153-163
Chronic debilitating diseases, 6-8, 31
Chronic tissue damage, 57
Clinical trials, 54-56, 70, 95
Collaborative Atorvastatin Diabetes Study (CARDS), 99
Colon cancer screening, see Colorectal cancer screening

Colonoscopy, 106, 180, 182
Colorectal cancer screening, 13, 105-108, 180-182
Confidence factor, 53
Contaminant exposure, 12, 45, 134
Contaminants, 38, 154
Contaminated water and health risks, 117-125
Controllable risk factors, 84
Coping behavior, in risk characterizations, 63-69
Coronary heart disease (CHD), see Heart disease

COX-2 enzyme, 74
COX-2 inhibitors, 74
Crassostrea ariakensis, 146-147, 149
Crassostrea virginica, 144, 147
C-reactive protein, 103
Crown-of-thorns starfish, 138-139
Cyclooxygenase 2 enzyme (COX-2), 74

D

Danish study, of cancer, 23, 34-35
DDT, 134-135
Death rates, due to contaminated water, 118
Death rates, from breast cancer, 23
Death rates, from cancer, 197
Death rates, from elevated cholesterol levels, 89-90
Death rates, from infectious disease, 117
Death rates, from smoking habits, 111-112
Decision-making process, 52
Deer mice, 137
Degree of accuracy, 16
Dermo, 143-145, 148
Diabetes, 6, 17, 91, 97
Diabetes drug study, 20-21
Diagnostic tests, 27
Digital rectal examination (DRE), 182
Dioxin, 6, 8-13, 45, 49, 51, 203
Disinfection by-products (DBPs), 117, 191, 215
DNA damage, 128
Doctor-patient relationship, 167, 169
Dose-response assessment, 46^7, 134-135, 215
Dose-response information, 47
Dose-response relationships, 67
Drinking water contamination and health risks, 117-125
Drinking water risk characterization theaters, 120-124
Drug companies, 7, 10, 20
Drug dosage, 46, 49, 57, 59
Drug efficacy, 20, 73-76
Drug marketing, 74
Drug side effects, 22-23, 27, 97

E

Ecological risk assessment (ERA), 13, 62-63, 133-139, 142, 146, 150, 155-157, 215
Ecological risks, 6, 12, 33
Ecosystems, health of, 6, 63, 133-134, 141, 215
Environmental carcinogens, 45
Environmental cleanup, 12, 54, 192
Environmental community, 42-43, 155
Environmental contaminants, 10, 13, 16, 33, 36, 53-54, 215
Environmental exposure levels, 61
Environmental hazards, 39
Environmental health risk assessments, 12
Environmental management practices, 7
Environmental Protection Agency (EPA), 8-9, 11-12, 39, 42-44, 60, 125, 127, 191, 194-195
Environmental regulations, 46
Environmental regulatory agencies, 10
Environmental risk assessment, 38, 62
Environmental stressors, 133, 136, 162
Epidemiological studies, of health, 57-58, 83, 129, 215
Estuaries, 141, 145, 153
Evidence-based decision, 5, 7
Exposure assessment, 46, 49-50, 215
Exposure time, 9, 11, 130
Exposure to air emissions, 37

F

False negative screening test, 79, 198
False positive screening test, 79, 198
Fecal occult blood (FOB) test, 106, 180
Federal and state environmental regulatory agencies, 54, 154-155, 195
Federal Clean Water Act (CWA), 154
Federal Safe Drinking Water Act, 191-192
Fluoride, 125
Food and Drug Administration (FDA), 40, 73, 92, 124-125
Framingham Study on the relationship of cholesterol levels and CHD, 84-85, 209-211
Framing health benefit, 32
Framing questions, 31
Framing risk data, 32

G

Gall flies, 137
Gastroenteritis, 118
General public and health risk, 31, 37-38, 193
Germ theory, 118-119
Gotzsche study, 175-176
Ground water contamination, 40

H

Haloacetic acids (HAAs), 120
Hantavirus, 137
Haplosporidium nelsoni, 143
Hazard identification, 46-47, 215
Hazard quotient (HQ), 50
Health benefit of risk, 7-8, 13, 19, 33, 52-53, 55, 69, 207
Healthcare planning, 178-179
Health care system, 167-168
Health decisions, 32
Health hazard, 47
Health problems, 6, 17, 50
Health protective, 41
Health risk factors, 13, 37
Health risks, measurable, 11
Health risks from environmental contamination, 70
Heart attack, 23, 73-74
Heart disease, 6, 22, 214
Heart disease and elevated cholestrol level, 83-92, 184, 209-212
Heart disease and statins, 93-103, 184
Heart Protection Study (HPS), 99, 101
High-risk patients, 178
HIV, 16, 53, 63
HIV RCTs, 35-36
HMG-CoA reductase, 95
Human health and environmental risks, 38-42
Human toxicity, 56-57

I

Illusion of certainty, 12-13, 69-70
Incidence of disease, 32
Individual risk vs. natiowide risk, 91-92, 102-103, 108
Industry consultants, 39
Informed decision, 19, 27
Informed patient, 167
International Agency for Research on Cancer (IARC), 127

K

Knapweed, 136

L

LC₅₀ , 47
LD₅₀ , 47
LDL cholesterol levels, 94, 96-97, 103
Lead exposure, 45
Lescol™, 93
Life expectancy, decreased, 27
Lifestyle behavior, 70
Lifetime risk, 215
Lifetime risk, with the RCT concept, 41
Lifetime risk data, 177-179
Lipid independent effects, of statins, 96
Lipitor™, 93, 98, 100
Liver damage, 22
Long-term contaminant behavior, 60
Lung cancer, 127-129, 131-132, 186

M

Malaria, 16
Mammogram RCT, 34-35
Mammograms, 13, 15, 18-19, 23-24, 26-27, 196
Mammography, 27, 35, 170-171, 175
Marketing of drugs, 74, 85-86
Maryland Department of Natural Resources, 146
Mathematical dose-response models, 59
Maximum Contaminant Level (MCL), 122-123
Mean, statistical, 203-204, 213
Media reports, of drugs, 24
Media reports, on medical breakthroughs, 167-168
Media reports, on smoking, 109
Medical health risk characterization, 188
Medical literature, 3, 5, 11, 38, 118, 197-199
Medical managed-care systems, 13
Medical recommendations, 174
Medical research, 169
Medical screening tests, 13
Medical treatment program, 53
Mesothelioma, 17
Mevacor™, 93
Microscopic disease-causing organisms, 143-145
Monte Carlo analysis, 206
MSX, 143-145, 148
Multiple Risk Factor Intervention Trial (MRFIT), 87, 210-211
Myocardial infarction, see Heart attack

N

National Academy of Sciences (NAS), 146
National Cancer Institute (NCI), 77, 182-183, 197
National Cholesterol Education Program (NCEP), 84, 94
National Research Council (NRC) study, 129, 145, 148, 150
Natural resources, destruction of, 38-39
Non-cancer effects, 12
Non-carcinogens, 47, 50
Non-governmental organizations, 39
Non-indigenous species, 145
Non-steroidal anti-inflammatory drugs (NSAIDs), 73
No observable adverse effect level (NOAEL), 47-48, 216
Number needed to treat (NNT), 21-22, 107, 216

O

Objective decision-making, 10
Organic chemicals, 10
Organic contaminants, 157
Oysters of Chesapeake Bay, health of, 141-151

P

Pathogenic risk, 120-122
Patient autonomy, 4, 167
Percentage comparisons, 32
Perkinsus marinus, 143
Pharmaceutical companies, 7, 10, 20-21, 184-185
Plaque buildup, effects of, 86, 236
Plasmodium, 16
Poliomyelitis, 16
Polio virus, 16
Pollution standards, 38
Polychlorinated biphenyls (PCBs), 45
Porewater, 160
Pravacol™, 93, 98, 100
Pravastatin, see Pravacol™
Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT), 101
Precautionary principle, 39-40
Predictability, of risk, 7
Primary prevention studies, of heart disease, 97-100, 216
Prostacyclin, 74
Prostaglandins, 74
Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, 198-199
Prostate cancer screening, 182-183, 198
Prostate proteins in blood, 12
Prostate Specific Antigen (PSA), 77, 182, 196, 216
Prostrate cancer screening, 77-81, 179
Public health experts, 54
Public health policy, 51
Pulp mills, 10, 37-40, 44-45, 49, 51, 62, 66

Q

Quantitative dose-response assessments, 59

R

Radiation risks, 24, 26, 127, 193
Radon, 13, 17, 33, 193, 216
Radon and risk of cancer, 127-132
Radon risk characterization theaters, 130-131
Reference dose (Rf D), 47-48, 50
Regulatory agencies, 9-10, 12, 54, 154-155
Relative death benefit, 24
Relative number comparisons, 32
Relative risk reduction (RRR), 19-25, 216-217
Relative risks, 10, 19-20
Rhabdomyolysis, 95
Rheumatoid arthritis, 73
Rice oil contamination, 45
Risk, concept of, 7
Risk analysis, 12, 39, 181
Risk assessment, 6-8, 12, 32, 38-39, 44, 217
Risk assessment, as scientific process, 45
Risk assessment, social policy dimensions of, 43-44
Risk assessment, steps in, 46-50
Risk aversion, 32
Risk characterization, 22-27, 46, 50, 87-91, 97-98, 106-108, 217
Risk Characterization Theater (RCT), 33-36, 63-65, 173-176, 185, 187, 217
Risk communication, 51-52, 217
Risk factors, 7-8, 12, 17-19, 32, 55, 83-84, 91, 97-98, 174, 217
Risk factors vs. cause and effect relationships, 170-172
Risk information, 33
Risk level, acceptable, 9, 12, 27, 42-43, 75, 108, 189-190, 213
Risk management, 26, 43-44, 218
Risk management, as political activity, 42-44
Risk managers, 50-51, 134
Risk numbers, 12
Risk reduction, 22
Risks, relative, 10
Risks from intervention, 27
Risks with dioxin, 8-12

S

Salmonella, 120-122, 124
Scandinavian Simvastatin Survival
Study Group, 101
Scientific risk assessment, 43
Screening tests, 13, 15, 19, 23, 27, 31, 36, 54, 70, 80, 105-108, 174, 178, 189, 196-197, 218
Secondary prevention studies, of heart disease, 97, 100
Sediment toxicity, see Chromium and sediment toxicity Sensitivity analysis, 205-207
Seven Countries Study of Smoking Risks, 111-113
Sigmoidoscopy, 180
Silent Spring, 6, 135
Simvastatin, see Zocor™

Site-specific risk assessments, 195
Slow-growing cancer, 79
Smoking behavior, 12, 70, 83, 128, 132
Smoking behavior, health effects of, 109-115
Smoking behavior and gender differences, 110-111
Smoking risk characterization theaters (RCTs), 111-115
Soil contamination, 40
Standard deviation, 203-204, 218
State regulatory agencies, 9, 12
Statin RCTs, 97-98
Statins, 13, 86, 218
Statins, lipid independent effects of, 96
Statins, side effects of, 95
Statins and incidence of coronary heart disease, 93-103, 184
Statistical mean, 203-204, 213
Stroke, 17, 97, 218
Surface water contamination, 40
Surgery, risks of, 4-5
Surgical biopsies, 26
Surgical removal of tumors, 79-80
Swedish women, study on, 34-35

T

Tabar study, 175-176
Tamoxifen, 24

Tap water contamination, see Drinking water contamination and health risks

Target level of acceptable risk, 195
TCE regulations, 40
Toxic contaminants, 9
Toxicity, animal, 57
Toxicity, human, 56-57
Toxicity effects, 46-41
Toxicity level, 9, 45
Trihalomethanes (THMs), 120, 122
Tumors, 57
Tumor screening, 77-81

U

Ultra-conservative screening levels, 65
Ultrasound scan, 4, 26
Unacceptable risk, 195
Uncertainty factor, in dose-response relationship, 59-60
Uncertainty factor, in exposure assessment, 60-62
Uncertainty factor, in hazard identification, 56-59
Uncertainty factor, of risk assessment, 7, 9, 11-12, 22, 26, 31-32, 39, 54-56, 135, 172
Uncertainty factor, statistical calculation of, 69, 203-207
US EPA's National Priority List database, 160
US Geological Survey, of freshwater sediments, 159
US Surgeon General's Report on the Health Consequences of Smoking (2004), 110

V

Value judgments, of medical information, 170
Value judgments, of risk level, 9, 27, 43, 75, 135
Vioxx™, 13, 33, 73, 174
Vioxx™ Gastrointestinal Outcomes Research (VIGOR) study, 74
Vioxx™ Risk Characterization Theater (RCT), 75-76
Visual display of data, 33

W

Waterborne contaminations, 191
Waterborne pathogens, 120, 122
Water movement, 61
Water quality regulations, 154-155
Water-sediment system, 157
West of Scotland Coronary Prevention Study (WOSCAPS), 99
Wingspread Declaration, 39-40

Z

Zero risk, 42
Zocor™, 93, 98, 100