Am J Epidemiol 2002; 156:586-587.
Copyright © 2002 by the
Johns Hopkins Bloomberg School of Public Health
BOOK REVIEWS |
How Much Risk? A Guide To Understanding Environmental Health Hazards
School of Public Health, University of California, Berkeley Berkeley, California 94720-7360
By Inge F. Goldstein and Martin Goldstein
ISBN 0–19–513994–1, Oxford University Press, New York, New York (Telephone: 800–451–7556, Fax: 919–677–1303, Web: www.oup-usa.org), 2002, 352 pp., $29.95
Everyone seems to know something or to have an opinion about environmental health, even if they are not directly familiar with the term. Movies like Erin Brockovich and A Civil Action and popular press reports of the latest study results have made such awareness almost universal. For the environmental health professional, putting these issues into proper perspective for others outside the field can require conveying considerable background in several scientific fields, including epidemiology, toxicology, radiobiology, physics, chemistry, molecular biology, genetics, statistics, and so on. Therefore, who among environmental epidemiologists has not at least occasionally wished for an accessible and balanced book that we can give our interested, nonepidemiologist friends to address their questions and concerns about the effects of low-level environmental exposures or "mysterious" clusters of disease? This book may be one answer to such wishes, although it goes further than that. How Much Risk? is by a wife-and-husband team, an environmental epidemiologist and a chemist, who are both experienced researchers and have jointly written several other books explaining scientific issues for laypeople.
The main intention of this book is to explain to a wide audience key concepts in environmental health, particularly environmental epidemiology, by using several high-profile issues as illustrations.
The book begins with an extensive, historically based description of the discovery and use of ionizing radiation and the subsequent realization of its risks, using this to illustrate the uncertainties in exposure measurement and the complexities of defining exposure-response relations. An entire chapter is devoted to radon. The difficulties in identifying whether there is an exposure threshold of carcinogenic effect are explained. Following that is a chapter on childhood leukemia in relation to nuclear plants, particularly Sellafield/Seascale in the United Kingdom. Cluster investigation issues are introduced here. The concept of the Poisson distribution is introduced and explained (judiciously avoiding the formula), and the effects of boundary issues, including the "Texas sharpshooter" phenomenon, are nicely described. A description that particularly appealed to me (although not necessarily original to this book) is "chance is lumpy," to describe the clustering of random events. I was pleased to see that the population-mixing hypothesis is introduced as a possible explanation for childhood leukemia. This chapter sets the scene for a comprehensive discussion in the next several chapters of three widely publicized (and controversial) environmental health issues: the relation (if any) between breast cancer and pesticide exposure; the association between certain cancers (particularly leukemia) and extremely low-frequency electromagnetic fields from power lines; and whether exposures from landfills cause cancer. These chapters were developed logically, with progressive construction of a framework of basic epidemiologic concepts, such as confounding, selection bias, statistical significance and power, confidence intervals, multiple comparisons, and causal inference criteria. These are generally well explained by example.
The final two chapters contain accounts of what is known about environmental causes of asthma and the health effects of arsenic in drinking water, both highly important and current environmental epidemiology topics.
This is not (and was clearly not intended to be) a book from which the epidemiologist will learn anything about epidemiologic methods. In fact, from that perspective, some of the descriptions may annoy. For example, in the description of an apparent meta-analysis of radiation risk (p. 71), at least as much credence appears to be given to the confidence limits as to the maximum likelihood estimate. The description of the healthy worker effect—not much more than "being able to work at all implies that one is healthier than the general population" (p. 76)—is inadequate. Such quibbles aside, there is much in the way of useful background information that environmental epidemiologists (and epidemiologists in general) are likely to gain from this book, particularly about the history of how current issues in environmental epidemiology developed. I appreciated the even-handed way in which the authors generally present their information, usually setting out both sides of the arguments. Anyone who reads this book with the idea that science produces clear-cut answers will rapidly be disabused of that notion.
For those of us used to reading journal papers, it can be annoying that particular statements are not referenced. However, there is a bibliography of sources and further reading for each chapter. These appear reasonable, with the one exception of the chapter on arsenic in water supplies, the bibliography for which consisted of one 1998 New York Times article on the Bangladesh arsenic crisis. This chapter is more superficial than the others, and one might surmise that it was added to give the book a particularly up-to-date appearance. The illustrations, often of a historical nature, are generally appropriate and interesting, sometimes amusing. However, I remain unclear why, in a chapter on breast cancer risk, it was necessary to include an early Florentine woodcut showing St. Agatha being tortured by having her breasts cut off (p. 138).
I enjoyed reading this book. Overall, it is well-written, balanced, interesting, and informative. In my opinion, it is unlikely to be suitable as a course textbook, at least at the graduate level, but it provides helpful background reading. Its place is mainly in public libraries, but public health libraries are also likely to find it a useful addition.
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