Re: Wing: Descriptive Epidemiology by Any Other Name...

[muckerheide@highway1.com (James Muckerheide)]

Ron L. Kathren wrote:
> 
> Vintage Dan Strom -- clearly thought out, well put (albeit lengthy).

I agree. And still no science. Equates Wing and Cohen by innuendo by
calling them "descriptive". Doesn't have to examine (or understand) the
data and analysis; like equating gold a baby poop because they are both
"yellow" :-)  Strom doesn't understand that being "descriptive" (being
"yellow") isn't the significant factor. The difference is in the
content.

Since EPA is now going around the country touting 10,000s of deaths from
particulates and ozone, etc, **justified by ecological studies**, (and
the hundreds of other studies that justify regulation and scientific
conclusions that are also solely based on such studies),I'm sure they
would be very interested in the definitive criticism and conclusions of
this "scientific" analysis. :-)

Then, he justifies case-control studies in the face of Wing's absolute
junk 1991 case-control results (which is more typical than not of such
small-numbers case-control studies that do essentially nothing to
control for unknown variations in assigned "doses", much less real
confounding factors). And this is with dosimetry! imagine making any
firm conclusions (ie, radon) with no dosimetry at all! Cohen's data is
based on voluminous data that itself normalizes statistical variability.
(As Frigerio said in the US population cancer: The error bars are
smaller than the dots on the graph! The smallest data point had more
than 10^5 deaths.)

Strom's 1991 valid criticisms of Wing's junk only scratched the surface
of its failings. (Since this is the Oak Ridge research population, with
3 pancreatic (not radiogenic) cancers that made the difference, the
internal contamination of these workers from the many reactor and
chemistry experiments were of enormous potential consequence; and even
many rad health effects researchers that left their dosimetry in their
office before going into the animal experiment rooms (some had personal
estimates of getting hundreds of R over years; it was part of what drove
Morgan to go off the deep end to the post-Watergate Congress because
"his program" didn't get enough 'respect' by Oak Ridge and AEC
management). 

Radon case-control is much worse except in some very special cases, like
Blot's case-control study in China of women with lung cancer who _did_
have a better basis to associate dose with home measurements (with a
full year of measurements in the 2 principle living areas, with women
who were _much_ less mobile than western counterparts). Again, higher
dose, lower lung cancer. In more definitive populations studies of radon
spas area residents; and the Guangdong Province populations (by health
authorities, not rad protection interests).

Finally, Strom again essentially argues, like it is significant, that
Cohen's work can't produce a quantitative model. Cohen himself, and
everyone knowledgeable, agrees. If fact they even understand that its
because of the effect on the mean of a threshold. It does, however,
absolutely eliminate the possibility that ther could be an effect at low
dose (which is *different* than stating that "the effect is..." which is
what the "ecological fallacy" states - perhaps you could explain that to
the EPA about the deaths they are ascribing to particulates and ozone
:-)

Note also the related comments apply here also about the unfounded,
basis for even "believing" that the uranium miners have lung cancer that
can be associated with radon. (Note that Nobel laureate Rosalyn Yalow
finds even that the histopathology of the cancer contradicts the
possibility that the lung cancer of the population could be assoicated
with radon based on the differences in the cancers of the smoking
miners!

This could go on, but suffice to say that it seems now that it is too
much to ask for "scientists" to do science any more; with actual numbers
and analysis. Polemics and obfuscation are not the same, except in
"government science"?  :-)

> Ron

For shame.
 
> >In 1877 Henle and Koch first addresssed association and causation (Evans
> >1976), and their work was revisited two decades ago (Rothman 1976).  Sir
> >Austin Bradford Hill published an influential work on association and
> >causation (Hill 1965).  Another perspective can be found in the work of
> >Susser (1991).  Canadian and U.S. leaders addressed the quality of
> >epidemiologic evidence under the title "Hierarchy of Evidence" (U.S.
> >Preventive Services Task Force 1989).  Most recently, the Federal Focus
> >expert panel explained why descriptive epidemiology studies don't get
> >much respect among risk analysts when they try to come to quantitative
> >conclusions (Graham et al. 1996).
> >
> >I have always been critical of the application of descriptive
> >epidemiology (e.g., ecologic studies) to quantitative problems (Strom
> >1997, 1991a).  "Descriptive studies are generally viewed as useful for
> >identifying or formulating causal hypotheses, but not a sufficient to
> >test such hypotheses, because they lack data on individuals, such as
> >individual exposures, potential confounding exposures, factors affecting
> >individual susceptibility, and potential biases.  In contrast, studies
> >generally termed 'analytic' aim to establish risk factors for
> >populations and individuals by ascertaining individual exposures and
> >controlling for other variables such as gender, age, race, or exposure
> >to other agents that could affect risk estimates independently
> >(potential 'confounders'), potential study biases, and variations in
> >host susceptibility.  There are two main types of analytic epidemiology:
> >case-control and cohort studies..."  This quote is from a new book
> >written by an expert panel of risk assessors in 1995 entitled
> >"Principles for Evaluating Epidemiologic Data in Regulatory Risk
> >Assessment"  (Graham et al. 1996).  The panel was comprised of an
> >international group (mostly from the USA, however) of well-respected,
> >middle-of-the-road risk assessors from universities, governments, and
> >industry groups.
> >
> >Steve Wing and colleagues have published a reanalysis of TMI health
> >effects data (Wing et al. 1997).  Both the new Wing study and the work
> >of B.L. Cohen (Cohen 1995) are in a category of descriptive
> >epidemiology, as opposed to analytical epidemiology.
> >
> >Whether descriptive or analytic, virtually all occupational and
> >environmental epidemiology studies are "observational" as opposed to
> >"experimental" (a.k.a. clinical or interventional) studies.  Since human
> >experimentation, outside of closely supervised clinical trials, is out
> >of the question, we are left with observational study designs which,
> >unfortunately, are not the most cogent designs because of uncontrolled
> >factors.  Neither the Wing TMI study nor Cohen's study are
> >"experiments," but rather compilations and analyses of whatever data are
> >available.
> >
> >If you are upset by Wing yet celebrate Cohen, I ask that you examine why
> >descriptive studies are compelling in one case and not in the other.  To
> >me, the bottom line is that neither have data for individuals, neither
> >has meaningful control for confounders and biases, and no amount of
> >statistical analysis will change that.  Both fail to meet many of the
> >criteria presented by leading risk analysts.
> >
> >I am reminded of the brouhaha about Steve Wing and co-workers' earlier
> >study of ORNL workers (Wing et al. 1991), which at least was an analytic
> >cohort study.  Lest I be branded as being on one side of the the issue
> >of radiation risks, I note that my reply to Wing (Strom 1991b) included
> >direct criticism of the methods as well as a reminder to consider the
> >Bradford Hill criteria (Hill 1965) for interpreting an association as
> >causal as reiterated by the Expert Panel (Graham et al. 1996).
> >
> >As an illustration of the Bradford Hill criteria, I offer a
> >tongue-in-cheek quote from my colleague Dwight Underhill: "In the
> >winter, I wear galoshes.  In the winter, I get colds.  Therefore,
> >galoshes cause colds."  Association?  22 standard deviations, I'd guess.
> >Causation?  Not by criteria I use.
> >
> >I must also confess that I do not form my opinions on the basis of books
> >published by what National Public Radio calls "the Libertarian Cato
> >Institute," which published Steve Milloy's "Junk Science" book.  At the
> >associated web site, one finds ecologic studies celebrated if they
> >support deregulation, no effects, or hormesis; and denounced if they
> >support regulation, or harmful effects of some agent or other.  Again,
> >these are not criteria I use to judge the weight of epidemiologic
> >evidence.
> >
> >References
> >
> >Cohen, B.L.  Test of the Linear-No Threshold Theory of Radiation
> >Carcinogenesis for Inhaled Radon Decay Products.  Health Physics
> >68(2):157-174; 1995.
> >
> >Evans, A.S.  Causation and Disease: The Henle-Koch Postulates Revisited.
> > Yale Journal of Biology and Medicine 49:175-195; 1976.
> >
> >Graham, J.D.; Koo, L.C.; Paustenbach, D.J.; Wynder, E.L.; Ashby, J.;
> >Carlo, G.; Cohen, S.M.; Evans, J.S.; Holland, W.; Matanoski, G.M.;
> >North, G.W.; Pershagen, G.; Schlesselman, J.J.; Starr, T.B.; Swenberg,
> >J.A.; Teta, M.J.; Wichmann, E.; Williams, G.M.; Kelly Jr., W.J.;
> >Auchter, T.G.; Landeck, S.; Ploger, W.D.  Principles for Evaluating
> >Epidemiologic Data in Regulatory Risk Assessment. Washington, DC:
> >Federal Focus, Inc. 1996.
> >
> >Hill, A.B.  The Environment and Disease: Association or Causation?
> >Proceedings of the Royal Society of Medicine 58:295-300; 1965.
> >
> >Rothman, K.J.  Causes.  American Journal of Epidemiology 104(6):587-592;
> >1976.
> >
> >Strom, D.J.  The Ecologic Fallacy.  Health Physics Society Newsletter
> >19(3):13; 1991a.
> >
> >Strom, D.J.  A Critique of "Mortality Among Workers at Oak Ridge
> >National Laboratory".  Nuclear News 34:67-74; 1991b.
> >
> >Strom, D.J.  Radon Study Shows Little Correlation.  Letter.  Health
> >Physics 72(3):488-489; 1997.
> >
> >Susser, M.W.  What is a cause and how do we know one?  A grammar for
> >pragmatic epidemiology.  American Journal of Epidemiology 133:635-648;
> >1991.
> >
> >U.S.Preventive Services Task Force.  Guide to Clinical Preventive
> >Services. Baltimore: Williams & Wilkins; 1989.
> >
> >Wing, S.; Shy, C.M.; Wood, J.L.; Wolf, S.; Cragle, D.L.; Frome, E.L.
> >Mortality Among Workers at Oak Ridge National Laboratory: Evidence of
> >Radiation Effects in Follow-Up Through 1984.  Journal of the American
> >Medical Association 265(11):1397-1402; 1991.
> >
> >Wing, S.; Richardson, D.; Armstrong, D.; Crawford-Brown, D.J.  A
> >Reevaluation of Cancer Incidence Near the Three Mile Island Nuclear
> >Plant: The Collision of Evidence and Assumptions.  Environmental Health
> >Perspectives 105(1):52-57; 1997.
> >
> >
> >The opinions expressed above are my own, and have not been reviewed or
> >approved by Battelle, the Pacific Northwest National Laboratory, or the
> >U.S. Department of Energy.
> >
> >Daniel J. Strom, Ph.D., CHP
> >Staff Scientist
> >Health Protection Department K3-56
> >Pacific Northwest National Laboratory
> >Battelle Boulevard, P.O. Box 999
> >Richland, WA 99352-0999 USA
> >(509) 375-2626
> >(509) 375-2019 fax
> >dj_strom@pnl.gov
> >
> >