27 September 2013. Earlier this week, the Health and Environment Alliance (HEAL) celebrated its 10th anniversary at the European Parliament in Brussels. Hosted by MEPs Peter Liese, Corinne Lepage, Jo Leinen, and Satu Hassi, formal remarks were presented by Dr. Peter van den Hazel, President of HEAL, Dr Zsuzsanna Jakab, Director of the WHO Regional Office for Europe, and Philippe Grandjean. Here are Dr. Grandjean’s speaking notes:
“As an academic working in the field of public health, I try to move out of the ivory tower and contribute “science translation”, i.e., responsible generalization that explains the implications of the research and current knowledge. However, advocacy is frowned upon, as an individual study and an individual scientist may have difficulty covering the full perspective of the evidence and associated uncertainties. Thus, the translation must stay within the boundaries of science and apply reasonable skepticism and will therefore often include words like maybe, perhaps, under certain circumstances, and conceivably.
In contrast, HEAL is expected to produce advocacy, and during its first 10 years of its existence, HEAL has done a superb job in using scientific documentation to propose effective means to better protect human health and the environment. In fact, HEAL’s proposals are often so well documented that they sound like visionary science translation.
However, I have one difficulty with HEAL: I am envious, although this is of course not HEAL’s fault. The reason is that our science traditions put me and my colleagues in an absurd position. When we evaluate drugs, we need statistical significance that they work, otherwise we will not consider them further. But with pollutants, we have to reach statistical significance that they are dangerous – otherwise they are considered safe. Thus, in practice, chemical pollutants – like people – are considered innocent, until proven otherwise. This non sequitur is paradox #1.
Even worse, science takes time, and we usually underestimate the adverse effects. Our studies may be too small, the follow-up incomplete, or measurements not sensitive enough. And when we fail to show beyond doubt that a chemical is dangerous, the study is called ‘negative’. In some cases, signs of adverse effects that are not quite significant are taken as proof that the hazard is innocuous. Further, vested interests may interfere by raising doubt and refuse to believe even a scientific study of the highest level of quality. This is paradox #2.
This situation has serious implications for the way we plan, conduct and utilize science in society. Because we are asked to provide solid evidence, and because any doubt must be addressed, we continue to study the same topics, thereby creating inertia and inhibiting innovation. I myself have authored or co-authored an overwhelming 100 scientific articles on mercury – mea culpa. And this is a general phenomenon. A total of 120,000 articles were published in the 72 major scientific journals on environmental health and toxicology during the first 10 years of this millennium. The top-10 chemicals were all metals. Each year, the journals publish a stunning 1,000 articles on lead, a serious pollutant that we are still trying to tackle. In contrast, of US EPA’s list of 13 top-priority chemicals, 5 had 0 publications since the list was published. Thus, our desire for convincing documentation results in almost endless flows of reports. We are polishing the same stones over and over. This is paradox #3.
As a physician, I am used to decision-making under uncertainty. If a child has typical pain in the lower right side of the abdomen and slight fever, appendicitis is suspected. We decide to operate, and in rare cases, our diagnosis is wrong and we remove a healthy appendix. But considering the alternative, this risk is certainly worthwhile. In regard to environmental chemicals, I find myself being unable to recommend similar precautionary action – that would represent advocacy. Instead, HEAL is acting like the caring physician, in this case with the environment as the patient. This is perhaps the most important, and general, paradox. I believe that all of these paradoxes justify my envy.
But HEAL is doing a superb job, and I admire everybody who is part of this highly qualified, well argued, and socially responsible effort. And my admiration is much greater than my envy.”
The paradoxes very clearly apply to chemical brain drain, too.