Getting Risk Right: Understanding the Science of Elusive Health Risks (2016)


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? Is the HPV vaccine safe? 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. In Getting Risk Right, Geoffrey C. Kabat shows how science works—and sometimes doesn't—and what separates these two very different outcomes.

Kabat seeks to help us 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 explains why certain risks are worth worrying about, while others are not. He emphasizes the variable quality of research in contested areas of health risks, as well as the professional, political, and methodological factors that can distort the research process. Drawing on recent systematic critiques of biomedical research and on insights from behavioral psychology, Getting Risk Right 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. In this book, Kabat provides a much-needed antidote to what has been called "an epidemic of false claims."

Brief Reviews

Geoffrey Kabat's vital, wide-ranging book cannot have arrived at a more fortuitous time. As individuals and societies, we are constantly asked to gauge risks—and we often do so hastily or irrationally, with grave consequences. In Getting Risk Right, Kabat provides a crucial framework to think about risks, biases, and judgment. Everyone should read his analysis—at once clear-eyed, thoughtful, and beautifully written—to understand the nature of risk. I cannot overstate the importance of this book.
                                                                                                        Siddhartha Mukherjee, author of The Emperor of All Maladies

Some risks are real, while others are much feared and speculated about, but of no portent. This important book by Geoffrey Kabat shows how the science of studying risks can lead to major discoveries that can improve the lives of millions by identifying and validating risks that do matter; or can ruin lives by propagating spurious, nonexistent risks in the public mind and in the scientific literature. Getting Risk Right carefully surveys a scientific field that is often the topic of hot debate and offers a balanced presentation. It is a fascinating read.
                                                                                         John Ioannidis, professor of medicine and health research and policy, 
                                                                                                                                                                                           Stanford University

Zika, Ebola, vaccines, dioxin, radon, black mold, environmental toxins. The media constantly bombards us with stories about unseen agents causing insidious harms. In Getting Risk Right, Geoffrey Kabat uses four case studies—BPA, cell phones, the HPV vaccine, and dietary supplements—to teach us not only whether these products are harmful but also how to grade information. Using Kabat's method, readers will be able to determine whether the next media-infused risk is a real one. Filled with cartoons, case histories, literary references, and fascinating asides, Getting Risk Right is the last book you will ever need to read on this subject.
                                                                                                                                      Paul A. Offit, author of Autism's False Prophets

 Geoffrey Kabat's writing, as usual, is phenomenally clear and expressive. His logical cadences are both airtight and a pleasure to read. His insights into the workings and mis-workings of science, the sociology of science, and the interplay of personalities and organizations are penetrating and precise, and above all original.
                                                                                                                        Steven D. Stellman, professor of clinical epidemiology,
                                                                                                                        Columbia University Mailman School of Public Health

 What matters most? How can we use scientific findings intelligently to set our public priorities? Through engaging anecdotes, and a clear-eyed analysis of the strengths and weaknesses of scientific work, Getting Risk Right helps us answer those questions.

Perhaps more importantly, Dr. Kabat enhances our understanding of how science leads to action, and how we can better use science to inform a more rational and productive public agenda.
                                                                                                        Sandro Galea, Dean, Boston University School of Public Health

An important study that teaches how to decipher science and medical news.
                                                                                                                                                                                                    Library Journal

It is not easy feat to take complex issues and make them both understandable, easily readable and interesting, but Kabat does just that in Getting Risk Right. For people who are trying to sort through the deluge of conflicting information that we see every day, this book is a must.
                                                                                                                         Josh Bloom, American Council on Science and Health

 If you worry about risks to your health from cellphones, genetically modified foods or any of the many threats that pop into the news, reading cancer epidemiologist Geoffrey C. Kabat’s new book may allay some of your fears by putting the headlines in perspective. But reassuring you is not Kabat’s sole mission. He’s also issuing a call to arms, urging his fellow scientists, policymakers and the media to rescue the science of environmental risks from what he presents as its current sorry state. In his view, this important field has fallen victim to low scientific standards, a rush to publish any study that hints at a possible connection between an environmental exposure and a disease, and highly politicized camps of researchers, often too dependent on government funding and media attention to critically examine their findings and do the studies needed to confirm or overturn their theories. “In many cases the resulting versions of the relevant science involve serious simplifications or distortions,” he writes.

It’s far easier for scientists to publish a study that seems to point to a new potential environmental risk than to publish a follow-up that fails to confirm the finding. Readers find news of possible health risks irresistible because – as Kabat points out – it plays into the universal human fear that we’re imperiled by forces beyond our control. Yet those same readers may not hear about other research that tends to refute the initial concerns. Moreover, despite solid evidence that smoking cigarettes, drinking too much, eating an unhealthy diet, being obese and failing to exercise are major environmental causes of illness within our power to change, humans tend to underestimate risks that stem from our behavior and overestimate those that are involuntary, including low-level exposure to substances in the environment.     

Kabat writes clearly, but his discussions of association, causality and toxicology are, at times, a bit technical for the general reader. More intriguing — and more unique, in my experience — is his insider's dissection of the psychology of how environmental studies are funded, reported and interpreted by their authors and by various audiences.           
                                                                                                                                                                                               Washington Post

When it comes to separating the wheat of good public health research from the chaff of studies that are mediocre or just plain bad, Albert Einstein College of Medicine epidemiologist Geoffrey Kabat is a national treasure. "Most research findings are false or exaggerated, and the more dramatic the result, the less likely it is to be true," he declares in his excellent new book Getting Risk Right. Kabat's earlier book, the superb Hyping Health Risks, thoroughly dismantled the prevalent medical myths that man-made chemicals, electromagnetic fields, radon, and passive smoking were significant causes of such illnesses as cancer and heart disease. His new book shows how scientific research, particularly epidemiology, so often goes wrong—and, importantly, how hard it is for it to go right.

Excellent.... A potent antidote to the toxic misinformation polluting our public health discourse.

This book will provide you with defensive armor against alarmist headlines and it will help you judge the credibility of new studies. Highly recommended.
                                                                                                                                             Harriet Hall, MD, Science-Based Medicine

Geoffrey Kabat, a cancer epidemiologist at Albert Einstein College of Medicine, […] offers a penetrating look at the science and politics of the BPA controversy, and many other health scares, in his new book. … his book represents a valiant attempt to help us to distinguish between real advances and unabashed efforts to scare us. If you are interested in penetrating the massive confusion surrounding health risks in the environment, this pithy book provides an indispensable primer.  
                                                                                                                                                                                    Jon Entine, Science 2.0

…for anyone wishing for an excellent review and discussion of the claim that cell phones cause cancer and the nature of the research used to argue for that claim, this chapter alone is worth the price of the book.                                                                                                                                                                                     Terence Hines, Skeptical Inquirer

Looking across the current landscape of environmental epidemiologic research and communication of its findings, he [Kabat] sees shining successes, illustrated by the establishment of human papillomavirus as the cause of cervical cancer and of specific herbal remedies as causes of nephropathy.  He contrasts those 2 case studies with 2 heavily studied and far murkier topics – cellular phones and endocrine disruptors. Addressing a wide audience, Kabat shows that it is difficult to find real causes of disease and critical to insist on scientific rigor in looking for them.

All epidemiologists must grapple with the arguments raised in Getting Risk Rightbecause they go to the heart of our enterprise: how we assess the current evidence, how we communicate to the press and public, and how much effort we devote to detecting and measuring particular environmental risks.
                                                                                                                              Patricia Hartge, American Journal of Epidemiology

In my view, the modern analysis of risk perception is deeply flawed in certain ways, but very valuable in other ways. This book is very relevant, and very current, and is the go-to place to assess health related risk issues, and I think it is very good. I do not agree with everything in it, but smart people reading a smart book … that’s OK, right?
                                                                                                                                                                               Greg Laden’s ScienceBlog 

The early chapters are designed to make us better consumers of risk information. They teach us (gently) about the epidemiological methods used to identify and measure risk, introducing us to case-control studies, which yield the odds ratios revealed by differences in exposure to hazards, and cohort studies, which yield the relative risk of consequences for those exposed and those not.

Kabat goes on to highlight the complexity of measuring risk in the real world. The controlled conditions of the laboratory – where there is usually only a single exposure under study – are a long way from the world of multiple exposures and multiple outcomes, with any one exposure potentially leading to multiple outcomes.

A new environmental hazard emerges seemingly every day, but many of these may be less about alerting the public to a meaningful risk than about getting a new paper published to increase the likelihood of getting a grant. Kabat does a valuable service here by citing real-world examples in a provocatively named section, “Why most research results are false.”

The primer part of the book also highlights some of the media- and quackery-induced scares of recent decades and provides a useful list of the key factors to be borne in mind in interpreting the “studies” that lead to those scares: misunderstandings about the difference between association and causation, the possibility of false positives, and publication bias. Quack scientists can quickly accumulate citations and gain media exposure, at the public’s cost, to benefit their careers. The presentation of risks can easily mislead: an increase from one in a billion to two in a billion is indeed “a doubling” in risk, but putting it that way can be highly misleading.
                                                                                                                                                               Stephen Duckett, Inside Story 

Geoffrey Kabat, an epidemiologist at Albert Einstein College of Medicine, dug deep on BPA, and he looked at it from a different direction. He looked at which views, which papers, which sides — you know each would tend to favor the data that supports their theory. So he looked at it from the point-of-view of which side had the greater tendency to cherry-pick the data. Which ones were more likely to narrow the focus to the papers that bolstered their point-of-view? Which ones grappled with the weakness of the BPA effect? Which papers were searching for alternative explanations? For example, what was the concentration of oral contraceptives in streams that could produce hormonal results? Which ones were citing the contrary data? Which ones were assessing the totality of the views vs. taking the litigious position?

…his conclusion was that one direction was quite clear — the groups that were doing the science and approaching it in a more scientific way consistently came out with the finding that BPA was not a significant threat.

That is an approach for being able to arrive at a way of finding your way through the maze — you look at what is the scientific approach.

Atul Gawande, National Academy of Sciences Colloquia