Manufacturing Uncertainty: Contested Science and the Protection of the Public’s Health and Environment

Michaels, David; Monforton, Celeste

doi:10.2105/ajph.2004.043059

Cited by 213 publications

(184 citation statements)

References 32 publications

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“…These causes include mixed messages and misinformation from various sources, including the deliberate “manufacturing” of scientific uncertainty in the service of other goals. 51 …”

Section: Implications For Research and Clinical Practicementioning

confidence: 99%

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Han

Klein

Arora

2011

Medical Decision Making

364

530

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Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, due in part to the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care, which are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. In this paper we attempt to address this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology, and developing a new integrative conceptual taxonomy of uncertainty. We propose a three-dimensional taxonomy that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. We show how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis, and suggesting appropriate strategies for its analysis and management.

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“…These causes include mixed messages and misinformation from various sources, including the deliberate “manufacturing” of scientific uncertainty in the service of other goals. 51 …”

Section: Implications For Research and Clinical Practicementioning

confidence: 99%

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Han

Klein

Arora

2011

Medical Decision Making

364

530

View full text Add to dashboard Cite

show abstract

“…Scientific uncertainty is the strategy of questioning the underlying science in order to prevent regulation [58]. In this study the food industry submissions to government select committees questioned the underlying science on the causes and prevention of obesity, thus creating uncertainty around the optimal evidence based policy tool.…”

Section: Vested Interests and Uncertaintymentioning

confidence: 99%

“…In this study the food industry submissions to government select committees questioned the underlying science on the causes and prevention of obesity, thus creating uncertainty around the optimal evidence based policy tool. Michaels and Monforton highlighted the same tactic by aspirin manufacturers and the tobacco industry seeking to delay the requirement for specific warning labels in the 1980s, observing that the tactic is now so commonly used in the United States that is unusual for the science behind a proposed public health or environmental regulation not to be challenged by an industry group [58].…”

Section: Vested Interests and Uncertaintymentioning

confidence: 99%

How do Vested Interests Maintain Outdated Policy? The Case of Food Marketing to New Zealand Children

Gauld¹

2011

TOHSPJ

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This paper examines the role of powerful vested interest groups in determining public health nutrition policy. With childhood obesity now being classified as an epidemic, television food advertising to children is a relevant case study, which is reported on in this article. The study consisted of qualitative interviews with members of the New Zealand food advertising policy community and documentary analysis of relevant submissions to two government inquiries, websites and policy documents related to food advertising to children. The findings categorised the positions of three identifiable interest groups. Each group's use of evidence and other influence strategies was examined in relation to their impact on government policy. We found the food industry to be tightly coordinated in their influence activities, public relations, partnership agreements and the creation of scientific uncertainty. Non government organisations were less coordinated in their advocacy for regulation, relying heavily on the use of scientific evidence to support their position. As a result industry groups dominated the processes to produce a policy outcome where the government was not acting in its own best economic interest, in terms of reducing the longer-term costs of obesity, or that of the public. The evidence from this study supports international recommendations for new approaches to health policymaking. Government needs to lead a collaborative process between vested interest groups to ensure industry groups do not have the upper hand. Such approaches would enable policy with positive public health outcomes.

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“…Corporate decision makers strived to achieve control over governmental regulation of tobacco 6 and food 7 to lower governmental classification of carcinogenic potential of their products 13 and to persuade governmental agencies to adopt permissible threshold concentrations of industrial products that are significantly higher than those reported to be hazardous to health. [14][15][16][17][18] They attempt to throw doubt on scientific evidence, [19][20][21][22][23] thus influencing not only regulatory agencies but also public opinion, courts, and juries. When the hazards of the products cannot be denied, they use administrative or court actions to delay implementation of regulation.…”

Section: Introductionmentioning

confidence: 99%

Corporation-induced Diseases, Upstream Epidemiologic Surveillance, and Urban Health

Jahiel

2008

J Urban Health

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Corporation-induced diseases are defined as diseases of consumers, workers, or community residents who have been exposed to disease agents contained in corporate products. To study the epidemiology and to guide expanded surveillance of these diseases, a new analytical framework is proposed. This framework is based on the agent-host-environment model and the upstream multilevel epidemiologic approach and posits an epidemiologic cascade starting with government-sanctioned corporate profit making and ending in a social cost, i.e., harm to population health. Each of the framework's levels addresses a specific level of analysis, including government, corporations, corporate conduits, the environment of the host, and the host. The explained variable at one level is also the explanatory variable at the next lower level. In this way, a causal chain can be followed along the epidemiologic cascade from the site of societal power down to the host. The framework thus describes the pathways by which corporate decisions filter down to disease production in the host and identifies opportunities for epidemiologic surveillance. Since the environment of city dwellers is strongly shaped by corporations that are far upstream and several levels away, the framework has relevance for the study of urban health. Corporations that influence the health of urban populations include developers and financial corporations that determine growth or decay of urban neighborhoods, as well as companies that use strategies based on neighborhood characteristics to sell products that harm consumer health. Epidemiological inquiry and surveillance are necessary at all levels to provide the knowledge needed for action to protect the health of the population. To achieve optimal inquiry and surveillance at the uppermost levels, epidemiologists will have to work with political scientists and other social scientists and to utilize novel sources of information.

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Manufacturing Uncertainty: Contested Science and the Protection of the Public’s Health and Environment

Cited by 213 publications

References 32 publications

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

How do Vested Interests Maintain Outdated Policy? The Case of Food Marketing to New Zealand Children

Corporation-induced Diseases, Upstream Epidemiologic Surveillance, and Urban Health

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