Risk, Uncertainty and Precaution in Science: The Threshold of the Toxicological Concern Approach in Food Toxicology

Environmental risk assessment is often affected by severe uncertainty. The frequently invoked precautionary principle helps to guide risk assessment and decision-making in the face of scientific uncertainty. In many contexts, however, uncertainties play a role not only in the application of scientific models but also in their development. Building on recent literature in the philosophy of science, this paper argues that precaution should be exercised at the stage when tools for risk assessment are developed as well as when they are used to inform decision-making. The relevance and consequences of this claim are discussed in the context of the threshold of the toxicological concern approach in food toxicology. I conclude that the approach does not meet the standards of an epistemic version of the precautionary principle.

The Past Suppression of Industry Knowledge of the Toxicity of Benzene to Humans and Potential Bias in Future Benzene Research

Petrochemical industry representatives often withhold information and misinterpret positive evidence of toxicity of benzene, even from their own research, also discouraging or delaying disclosure of findings of adverse effects to the public. They now appear to be attempting to influence study results in industry's favor by offering predetermined conclusions about study results as part of an effort to draw financial support for the studies. The American Petroleum Institute is currently raising funds for benzene research being conducted in China for which it has already announced the intended conclusions.

Taking action on developmental toxicity: scientists' duties to protect children

BACKGROUND

Although adaptation and proper biological functioning require developmental programming, pollutant interference can cause developmental toxicity or DT.

OBJECTIVES

This commentary assesses whether it is ethical for citizens/physicians/scientists to allow avoidable DT.

METHODS

Using conceptual, economic, ethical, and logical analysis, the commentary assesses what major ethical theories and objectors would say regarding the defensibility of allowing avoidable DT.

RESULTS

The commentary argues that (1) none of the four major ethical theories (based, respectively, on virtue, natural law, utility, or equity) can consistently defend avoidable DT because it unjustifiably harms, respectively, individual human flourishing, human life, the greatest good, and equality. (2) Justice also requires leaving "as much and as good" biological resources for all, including future generations possibly harmed if epigenetic change is heritable. (3) Scientists/physicians have greater justice-based duties, than ordinary/average citizens, to help stop DT because they help cause it and have greater professional abilities/opportunities to help stop it. (4) Scientists/physicians likewise have greater justice-based duties, than ordinary/average citizens, to help stop DT because they benefit more from it, given their relatively greater education/consumption/income. The paper shows that major objections to (3)-(4) fail on logical, ethical, or scientific grounds, then closes with practical suggestions for implementing its proposals.

CONCLUSIONS

Because allowing avoidable DT is ethically indefensible, citizens---and especially physicians/scientists---have justice-based duties to help stop DT.

[The challenges of the ethics of personalism to clinical toxicology]

The fields of philosophical anthropology and the ethics of personalism overlap in the area of many difficult personal situations involving clinical toxicology. These therapeutic situations need an integral, multidimensional, and personal approach for both the patient and the toxicologist. This means that man is treated not only as a physical (biological) being but also there is an appreciation for the mental sphere, which includes rational, emotional, and spiritual elements while not forgetting that the human person is also part of the human community. Studying such an individual's personal decision as suicide, we must realize that it's not just physiological or biochemical poisons but also includes the poisoning of the psyche, as well as poisoning relationships with loved ones (family), poisoning social relations (in school or the workplace) and poisoning the spirit, in other words, there is no meaning in life itself, nor the meaning of God's existence, nor the meaning of faith, hope and love. Not only is there a greater "variety of poisons" than before, they are much more extensive and deep. For example, we can name environmental pollution, industrial poisons, chemical waste, genetic modification, powerful medications, or even the toxic social environment of evil ideas, malicious manipulation of the human mind (destructive religious sects). In approaching the challenges of clinical toxicology, the doctor must not only be a specialist in chemistry, biochemistry and pharmacology. What then is of future of toxicology because of this human dimension (anthropological, ethical and spiritual) of this teaching? As today marks the occasion of the 45th anniversary of the Clinic of Toxicology CM UJ, should we shape the ethos of young doctors who want to deal with toxicology seriously?

The use of non-human primates in regulatory toxicology: comments submitted by FRAME to the Home Office

The Home Office have circulated a document that summarises the discussions of a Primate Stakeholders Forum. The Forum took place in January 2004, and was convened to address the issues raised and the recommendations made in the Animal Procedures Committee 2002 report on the use of primates under the Animals (Scientific Procedures) Act 1986. The report emphasises the need for more resources focused on alternatives to toxicological testing in primates, including harmonising worldwide regulatory requirements, investigating the relevance of primate models, and improving the retrospective analysis of procedures involving primates. The document called for reasoned comments about the report to be submitted to the Home Office. In response, FRAME submitted a comprehensive paper, which evaluated each of the Animal Procedures Committees recommendations, along with the Home Office Forums comments. FRAME believes that, in coming to a decision as to whether primates should be used for regulatory testing, there must be full consideration of all the information available, including whether the ethological needs of any given species can be met prior to, during and following experimental use. Where these needs cannot be met, there must be a concerted effort to develop alternative models for research and testing. However, this should not detract from the ultimate goal of phasing out primate research altogether.

Ethical, Legal, and Social Issues: Our Children's Future

A convergence of issues suggests that protecting child health is not so much a matter of research, but rather a matter of policy and advocacy. First, we have well-articulated views of a vision for child health. Second, we have experience and toxicological research findings demonstrating the adverse health effects of hazardous chemicals on children and recognize that children are more sensitive than adults to chemical exposures. Results from toxicology research have motivated many regulatory and legal actions, and public policy decisions, including the banning of some pesticides, reducing exposures in the workplace, and lowering of acceptable blood lead levels in children. We also know that childhood disabilities from chemical exposure during developmental are often not treatable and therefore must be prevented. Finally, we have an increasingly well-defined framework for discussing social and ethical responsibility to our children. New discoveries in the basic biological and toxicological sciences have challenged our bioethical thinking and societal decision-making. This paper will explore the ethical, legal, and social issues raised by the toxicological sciences first by examining some hard lesson learned about childhood effects of chemicals and then by examining the difficult policy and research decisions that must be made as we address our need for additional information about the health effects of chemicals on adults and children and the impact of having this information. The precautionary principle will be considered as an alternative decision-making approach as well as exploring the concept of the citizen toxicologist (CT). As Garrett Hardin pointed out many years ago, the problems we face often have no technical solutions, but rather require a policy-based approach. This paper will be of interest to the public and health professionals concerned about the broader impact of toxicological research on bioethical and societal decision-making.

Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry

BACKGROUND

Prenatal and postnatal exposure to tobacco smoke adversely affects maternal and child health. Secondhand smoke (SHS) has been linked causally with sudden infant death syndrome (SIDS) in major health reports. In 1992, the US Environmental Protection Agency (EPA) first noted an association between SHS and SIDS, and both prenatal exposure and postnatal SHS exposure were listed as independent risk factors for SIDS in a 1997 California EPA report (republished in 1999 by the National Cancer Institute) and a 2004 US Surgeon General report. The tobacco industry has used scientific consultants to attack the evidence that SHS causes disease, most often lung cancer. Little is known about the industry's strategies to contest the evidence on maternal and child health. In 2001, a review was published on SIDS that acknowledged funding from the Philip Morris (PM) tobacco company. Tobacco industry documents related to this review were examined to identify the company's influence on the content and conclusions of this review.

METHODS

Tobacco industry documents include 40 million pages of internal memos and reports made available to the public as a result of litigation settlements against the tobacco industry in the United States. Between November 2003 and January 2004, we searched tobacco industry document Internet sites from the University of California Legacy Tobacco Documents Library and the Tobacco Documents Online website. Key terms included "SIDS" and names of key persons. Two authors conducted independent searches with similar key terms, reviewed the documents, and agreed on relevancy through consensus. Thirty documents were identified as relevant. Two drafts (an early version and a final version) of an industry-funded review article on SIDS were identified, and 2 authors independently compared these drafts with the final publication. Formal comments by PM executives made in response to the first draft were also reviewed. We used Science Citation Index in July 2004 to determine citation patterns for the referenced SIDS reviews.

RESULTS

PM executives feared that SHS and maternal and child health issues would create a powerful and emotional impetus for smoke-free areas in the home, public areas, and the workplace. In response to the 1992 US EPA report on SHS, the Science and Technology Department of PM's Switzerland subsidiary, Fabriques de Tabac Reunies, searched for "independent" consultants to publish articles addressing SHS. The first industry-funded article was a literature review focusing on smoking and SIDS, conducted by consultant Peter Lee and co-author Allison Thornton, which stated that the association between parental smoking and SIDS could have been attributable to the failure to control fully for confounders. That first review has only been cited once, in the subsequent industry-funded review. In 1997, PM commissioned a consultant, Frank Sullivan, to write a review, with coauthor Susan Barlow, of all possible risk factors for SIDS. The first draft concluded that prenatal and postnatal smoking exposures are both independent risk factors for SIDS. After receiving comments and meeting with PM scientific executives, Sullivan changed his original conclusions on smoking and SIDS. The final draft was changed to emphasize the effects of prenatal maternal smoking and to conclude that postnatal SHS effects were "less well established." Changes in the draft to support this new conclusion included descriptions of Peter Lee's industry-funded review, a 1999 negative but underpowered study of SIDS risk and urinary cotinine levels, and criticisms of the conclusions of the National Cancer Institute report that SHS was causally associated with SIDS. In April 2001, the Sullivan review was published in the United Kingdom journal Paediatric and Perinatal Epidemiology, with a disclosure statement that acknowledged financial support from PM but did not acknowledge contributions from PM executives in the preparation of the review. By 2004, the Sullivan SIDS review had been cited at least 19 times in the medical literature.

CONCLUSIONS

PM executives responded to corporate concerns about the possible adverse effects of SHS on maternal and child health by commissioning consultants to write review articles for publication in the medical literature. PM executives successfully encouraged one author to change his original conclusion that SHS is an independent risk factor for SIDS to state that the role of SHS is "less well established." These statements are consistent with PM's corporate position that active smoking causes disease but only public health officials conclude the same for SHS. The author's disclosure of industry funding did not reveal the full extent of PM's involvement in shaping the content of the article. This analysis suggests that accepting tobacco industry funds can disrupt the integrity of the scientific process. The background of this SIDS review is relevant for institutions engaged in the debate about accepting or eschewing funding from the tobacco industry. Those who support acceptance of tobacco industry funds argue that academic authors retain the right to publish their work and maintain final approval of the written product, but this argument fails to recognize that the tobacco industry funds work to ensure that messages favorable to the industry are published and disseminated. Clinicians, parents, and public health officials are most vulnerable to the changed conclusions of the SIDS review. The national SIDS "Back to Sleep" campaign has been very successful in reducing SIDS rates. However, estimates of SIDS risk from SHS (odds ratios range from 1.4 to 5.1) have considerable overlap with estimates of risk from prone sleep positioning (odds ratios range from 1.7 to 12.9). With the Back to Sleep campaign well underway, efforts to address parental smoking behavior in both the prenatal and postnatal periods should be intensified. The tobacco industry's disinformation campaign on SHS and maternal and child health can be counteracted within clinicians' offices.

The occupational toxicologist: professionalism, morality and ethical standards in the context of legal and non-litigation issues

By its very nature, practice and intended applications, the profession of occupational toxicology has individual and collective responsibilities related to the design, conduct, interpretation and extrapolation of laboratory and controlled human clinical studies in order to determine the potential for industrial xenobiotics to produce adverse effects. The implications for health-related adverse effects in the workplace, and in the domestic and general environment carries many and various responsibilities for the toxicologist which are related to multiple and wide-ranging ethical issues. This review presents and discusses some of the major areas where the occupational toxicologist may experience potential ethical problems related to the conduct of routine professional activities. Emphasis is placed on the design, conduct, interpretation and reporting of laboratory studies; animal welfare; regulatory activities; human clinical volunteer studies; roles and responsibilities in defining workplace safety and protective measures; malpractices in various disciplines and work practices; misconduct in publication; and codes of ethical behavior.

Progressing toward the reduction, refinement and replacement of laboratory animal procedures: thoughts on some encounters with Dr Iain Purchase

A variety of encounters with Dr Iain Purchase over the last 25 years are reviewed in relation to their significance in terms of progress toward the reduction, refinement and replacement of animal procedures in toxicology and toxicity testing. Included are the work of the first FRAME Toxicity Committee and the FRAME International Alternatives Validation Scheme, the International Conferences on Practical In Vitro Toxicology and the foundation of Toxicology in Vitro, the work of an Institute of Medical Ethics working party on issues raised by animal experimentation and alternative approaches, the need for in vitro assays for chemical carcinogenesis based on the transformation of human cells, the problem presented by the human hazard potential of thousands of chemicals already in use before modern regulations for the registration of new chemicals came into force, and the importance of testing strategies with a focus on the integrated use of non-animal computer-based and in vitro test systems.

[Dignity of the medical toxicologist in the context of medical ethos]

On beginning of article two sources of medical ethics: Hippocratic Oath and Good Samaritan (from the parable of Jesus Christ). First, it is paradigm of medicine from antiquity to present times, second this paradigm describes from side of Christian theology and anthropological dates. From point of sight of personalism of traditional source of medical, they make up foundation to appearance of dignity physician of toxicology. Notion of dignity contains many most important guild of physicians in our times, especially physician of toxicology. Principle part of article analyses dignity of physician in worry about life, co-operation with different doctors as well as in context of conscience and in challenges of future. Progress of clinical toxicology has to be connected with moral values and the dignity of medical profession and physician's status.

[Are acute toxicity testing and the three Rs rule reconcilable? Example of the lethal dose 50 determination]

Toxicity assessment and demonstration of innocuousness of chemical compounds have been part of the research studies conducted in the fields of pharmacy, agriculture and chemical industry for years. Acute systemic toxicity studies are an important element of the safety evaluation. They remain compulsory for regulatory purposes and important for the public opinion that does not accept the risk anymore. Evolutions of the ethics in animal experiments foster a necessary reduction of the number of animals involved in this type of experiments, following the well-known principle of the three Rs rule of Russell and Burch (1959) (Reduction, refinement and replacement). These two views seem in contradiction. Using the example of acute toxicity testing and focusing on the now very criticized parameter lethal dose 50, we will present approaches, including statistical ones, that a toxicologist can use, when free to choose, to keep on conducting the indispensable in vivo studies while abiding by ethical recommendations.

Animal experimentation in snake venom research and in vitro alternatives

Current experimental techniques used in snake venom research (with and without the use of animals) are reviewed. The emphasis is on the reduction of the use of animals in the development of antivenoms for the clinical treatment of snakebite. Diagnostic and research techniques for the major pathologies of envenoming are described and those using animals are contrasted with non-sentient methods where possible. In particular, LD50 and ED50 assays using animals (in vivo) and fertilised eggs (in vivo, non-sentient) are compared as well as in vitro procedures (ELISA and haemolytic test) for ED50 estimations. The social context of antivenom production, supply and demand is outlined together with the consequent tension between the benefits derived and the increase in opposition to experiments on animals. Stringent regulations governing the use of animals, limited research funds and public pressure all focus the need for progress towards non-animal, or non-sentient, research methods. Some achievements are noted but success is hampered by lack of detailed knowledge of the many constituents of venom which have to be assessed as a whole rather than individually. The only way to evaluate the net pathological effect of venom is to use a living system, usually a rodent, and similarly, the efficacy of antivenoms is also measured in vivo. The pre-clinical testing of antivenoms in animals is therefore a legal requirement in many countries and is strictly monitored by government authorities. New technologies applied to the characterisation of individual venom proteins should enable novel in vitro assays to be designed thus reducing the number of animals required. In the meantime, the principles of Reduce, Refine and Replace relating to animals in research are increasingly endorsed by those working in the field and the many agencies regulating ethical and research policy.

Toxicology and new social ethics for animals

The issue of animal treatment has emerged as a major social concern over the past three decades. This ramified in a new ethic for animal treatment that goes beyond concern about cruelty and attempts to eliminate animal pain and suffering, whatever its source. This is evidenced by laws governing animal research in many countries. Insofar as toxicology can entail significant and prolonged animal suffering, it is at loggerheads with this new ethic. Ways are suggested for the toxicological community to put itself in harmony with the ethic and thereby preserve its autonomy.

Environmental enrichment of nonhuman primates, dogs and rabbits used in toxicology studies

The increasing emphasis on the provision of environmental enrichment to laboratory animals, vis-à-vis the USDA Animal Welfare Regulations, the Guide for the Care and Use of Laboratory Animals (NRC 1996), and a potential forthcoming policy from the USDA on the subject, can be difficult to accommodate in a toxicology research environment. A summary will be provided of current requirements and recommendations. Then, strategies for meeting regulatory requirements will be described for non-rodent animals used in toxicology research. These strategies will address methods of both social enrichment, such as pair or group housing, as well as non-social enrichment, such as cage furniture, food enrichments, and toys. In addition, the value of positive interactions with staff (e.g., through training paradigms or socialization programs) will also be discussed. Apparent in the discussion of these strategies will be an overarching recognition of the necessity to avoid introducing confounding variables into the research project and to avoid compromising animal health. The roles of the Institutional Animal Care and Use Committee (IACUC) and the attending veterinarian in helping scientists balance animal well-being, the scientific enterprise and the regulatory environment will be described.