A safe bet or Russian roulette?

August 17, 2007

Risks are borne voluntarily, as in the case of medical tests or elective surgery, or thrust upon us, as in the case of exposure to environmental contamination. How should the average person interpret the daily flood of news reports on sometimes contradictory studies" Do certain actions pose greater risks than not acting at all" All too often, health benefits and risk statements are presented as if they were authoritative, definitive, and based on compelling evidence. However, all they provide is the illusion of certainty.

The Illusion of Certainty: Health Benefits and Risks peels away the "veneer of certainty" which is attached to health benefit and risk information. Authors Erik Rifkin and Edward Bouwer, recognized experts in the field of health risk assessment, help patients and their families get more involved in making medical decisions and provide guidance to citizens when confronting critical questions about the environment.

The researchers said they wrote the book because they believe that the average person, who must make critical decisions about health risks, is not getting a complete picture. They discovered that health-related choices that sometimes sound straightforward and obvious are often much more uncertain and controversial when the risk statistics are viewed in a different way.

"I've been involved in human health and environmental risk assessment for more than 30 years," Rifkin said. "It became clear to me during this time that the uncertainty in health risk assessment had gotten lost, and the numbers had taken on a life of their own."

In their book, Rifkin and Bouwer give readers an easy way to visualize the absolute risk numbers through a graphic called the Risk Characterization Theater. This diagram is patterned after a seating chart for a theater with space for 1,000 people. The authors darken the "seats" that represent the number of people who are likely to benefit from a screening test or a medication or who may be at increased risk from exposure to an environmental contaminant.

"These theater charts make it easier for people to see what the case studies are referring to," Bouwer said. "We're trying to give people some new tools to help them make better informed decisions about health risks."

Topics addressed are of interest to literally millions of individuals throughout the world − the true benefits of screening tests for breast cancer, prostate cancer, and colorectal cancer; the benefits and risks from chlorinating drinking water; the benefits from taking statins and the real risks of elevated blood serum cholesterol; the risks from smoking; and the risks from exposure to environmental contaminants such as dioxin and radon.

By putting the complexities of risk analysis in terms the general reader can identify with, The Illusion of Certainty will empower people to make well-informed decisions. In the book's Foreword, Dr. Jared Cohon, President of Carnegie Mellon University, says, "In my view, a book like this is long overdue, and we all will be better for the reflection and debate it is likely to stimulate among scientists and policymakers."
Erik Rifkin is the president of an environmental consulting firm in Baltimore, MD, that specializes in the characterization of ecological and human health risks from exposure to soil, water, air and sediments. Edward J. Bouwer is a professor of environmental engineering at Johns Hopkins University, Baltimore, MD.

Erik Rifkin, Edward Bouwer
The Illusion of Certainty
Health Benefits and Risks
2007. XX, 244 p. 37 illus.
Hardcover. $79.95, EUR 62.95, £ 48.50
ISBN 978-0-387-48570-6

The book will be available in paperback for $29.95 (EUR 24.95; ₤19.00) in October 2007.

The authors are available for interviews.

Digital photos of Rifkin and Bouwer are available.

Related Links

Baltimore Sun article on The Illusion of Certainty (free registration required at Sun site): http://www.baltimoresun.com/news/health/bal-id.hs.risk05aug05,0,3165339.story


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