Tobacco Documents Online

A-16 investments in human capital and social resources, by which income inequality may be related to health outcomes. Finally, we considered the impact of income inequality and changes in income inequality on mortality trends." "The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91." "There was a significarit correlation between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprison- ment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends." [66] "Editorial: Understanding Sociodemographic Differences in Health -- The Role of Funda- mental Social Causes," B.G. Link and J.C. Phelan, American Journal of Public Health 86: 471-473, 1996 "Several articles in this issue of the Journal docu- ment associations between sociodemographic factors and health-related conditions. Consistent readers of the Journal will note that this is not an unusual phenomenon." "From one point of view, this repeated documenta- tion of the association between sociodemographic factors and health belies a distinct lack of progress and indicates a major problem in the field of public health." "But there is an important principle of social epide- miology that suggests that we will never be able to, nor ETS/IAQ REPORT, ISSUE 123 should we try to, turn our attention away from the sociodemographic factors themselves. Put simply, this principle states that societies shape patterns of disease." "From this perspective, our continued attention to sociodemographic factors is not a sign of stalled progress, but rather a simple reflection of the fact that societies continue to shape patterns of disease through time and that it is the job of public health professionals to stay vibrantly attuned to these processes." "[H]istory gives credence to the somewhat startling and counterintuitive notion that social patterns of disease may persist despite effective interventions on potent risk factors. We illustrate with the case of socioeconomic status and health....[B]y the 1960s, many of the factors previously identified as linking socioeconomic status to disease had been addressed, and one might have expected the association to weaken and perhaps disappear altogether. But it has not. Recent studies demonstrate an enduring or even increasing association between socioeconomic status and many disease outcomes." "[T]he comparison of past and present risk factors reveals an important fact: as some risk factors mediat- ing the association between socioeconomic status_and c'..sease were eradicated, others emerged. Consequently, the association between socioeconomic status and disease has endured." "[W]e propose that such enduring associations between sociodemographic factors and disease are predictable and perhaps unavoidable, because many social conditions are what we have called 'fundamental social causes' of disease. As we define it, a fundamental social cause involves resources like knowledge, money, power, prestige, and social connections that strongly influence people's ability to avoid risks and to mini- mize tlie consequences of disease once it occurs. Because of the very general utility of these social and economic resourcz~s, fundamental causes are linked to multiple disease outcomes through multiple risk-factor mechanisms." "In a dynamic system, fundamental causes are likely to emerge. This is because the resources embodied in fundamental causes can be transported from one situation to another. Consequently, as health-related situations change, those with the most resources are best able to avoid diseases and their consequences. SHB 93140341

MAY 10, 1996 Thus, no matter what the profile of diseases and known risks happens to be at any given time, those who have greater access to important social and economic resources will be less afflicted by disease." [67] "Lack of Effect of Long-Term Supplementation with Beta Carotene on the Incidence of Malig- nant Neoplasms and Cardiovascular Disease," C.H. Hennekens, J.E. Buring, J.E. Manson, M. Stampfer, B. Rosner, N.R. Cook, C. Eclanger, F. LaMotte, J.M. Gaziano, P.M. R.idker, W. Willett, and R. Peto, New England journal of Medicine 334: 1145-1149, 1996 "Observational studies suggest that people who consume more fruits and vegetables containing beta carotene have somewhat lower risks of cancer and cardiovascular disease, and earlier basic research suggested plausible mechanisms. Because large ran- domized trials of long duration were necessary to test this hypothesis directly, we conducted a trial of beta carotene supplementation." "In a randomized, double-blind, placebo-controlled trial of beta carotene (50 mg on alternate days), we enrolled 22,071 male physicians, 40 to 84 years of age, in the United States; 11 percent were current smo' ers and 39 percent were former smokers at the beginning of the study in 1982." "This large-scale, randomized trial among appar- ently healthy, well-nourished men demonstrated no statistically significant benefit or harm due to 12 years of beta carotene supplementation in terms of malig- nant neoplasms, cardiovascular disease, or death. Because of the long duration of the trial, these findings are particularly informative, and the large sample and narrow confidence intervals exclude even a small overall benefit or harm due to beta carotene with a high degree of assurance. However, for indi- vidual end points such as stroke, myocardial infarction, and particular types of cancer, the confi- dence intervals are wider and do not preclude the possibility of a small absolute effect. In view of the slow development of many cancers, follow-up in this and the other trials of beta carotene will continue even though treatment has ceased, in case any benefits or hazards become clear later." A-17 "Factors that could, at least in theory, have produced a false finding of no benefit or harm include an inadequate dose of beta carotene or poor compliance with the assigned treatment. The dose of beta carotene used in the trial, however, placed participants in the top few percentiles of the general population with respect to usual intake, while minimizing noticeable yellowing of the skin.... This intake is above the level of dietary beta carotene consumption that is associated with benefit in observational studies and is roughly equivalent in effects on blood levels to about two carrots a day." [68] "Effects of a Combination of Beta Carotene and Vitamin A on Lung Cancer and Cardiovas- cular Disease," G.S. Omenn, G.E. Goodman, M.D. Thornquist, J. Balmes, M.R. Cullen, A. Glass, J.P. Keogh, F.L. Meyskens, B. Valanis, J.H. Williams, S. Barnhart, and S. Hammar, New England journal of Medicine 334: 1150-1155, 1996 "We conducted a multicenter, randomized, double-blind, placebo-controlled primary prevention trial -- the Beta-Carotene and Retinol Efficacy Trial -- involving a total of 18,314 smokers, former smokers, and workers exposed to asbestos. The effects of a combination of 30 mg of beta carotene per day and 25,000 IU of retinol (vitamin A) in the form of retinyl palmitate per day on the primary end point, the incidence of lung cancer, were compared with those of placebo." "This report presents interim efficacy results of the CARET study, which coincided with the announce- ment of the steering committee's decision on January 11, 1996, to stop the trial's active intervention. Follow-up for additional end points is expected to continue for another five years." "The results of the trial are troubling. There was no support for a beneficial effect of beta carotene or vitamin A, in spite of the large advantages inferred from observational epidemiologic comparisons of extreme quintiles or quartiles of dietary intake of fruits and vegetables or of dietary intake or serum levels of beta carotene or vitamin A. With 73,135 person-years of follow-up, the active-treatment group had a 28 percent higher incidence of lung cancer than the placebo group, and the overall mortality rate and the SHB

A-18 rate of death from cardiovascular causes were higher by 17 percent and 26 percent, respectively." "The second interim analysis led our safety and endpoints monitoring committee and steering commit- tee to recognize the extremely limited pros-)ect of a favorable overall effect, as well as the possibility of true adverse effects." "We have no explanation for the possible adverse associations that we have observed to date. There was no evidence of systemic toxicity in any organ from the vitamin A or, except for the expected skin yellowing, the beta carotene." "The results of our study and the ATBC Cancer Prevention Study in populations at high risk for lung cancer and cardiovascular disease and the finding of the Physicians' Health Study of no benefit or harm after 12 years of beta carotene treatment clearly do not support the widely accepted conclusion drawn from observational epidemiologic studies that beta carotene is a primary component responsible for the association of lower risks of cancer and death from cardiovascular causes with high intakes of fruits and vegetables." "Our findings provide important new information with respect to public policy and public health.... [T]hey make it clear that there can be little enthusiasm about the efficacy or safety of supplemental beta carotene or vitamin A in efforts to reduce the burdens of cancer or heart disease in certain populations. However, we still recommend the dietary intake of fruits and vegetables." ETS/IAQ REPORT, iSSUE 123 "Two reports in this issue of the journal should put to rest any remaining hopes that, for adults, beta carotene suppleme-ts may be an effective means of lo,vering the risk of cancer and cardiovascular disease." "The disappointing results of the clinical trial of beta carotene reaffirm the important of solid scientific knowledge as the basis of disease-prevention strategies. Inferences that beta carotene can prevent cancer and cardiovascular disease were drawn largely from observa- tions of a lower risk associated with vegetable and fruit consumption; they lacked strong support from clinical trials or mechanistic studies." "[N]o one should discount the importance of the findings of epidemiologic studies of diet and chronic disease. In most such studies, persons who ate a relatively large quantity of vegetables, fruits, and grains were found to have a profoundly lower risk of death, particularly from cardiovascular disease and cancer. Antioxidant vitamins may not account for all (or even any) of the benefits associated with this dietary pattern, and the myriad other substances in plants should be examined for possible preventive properties." GENOTOXICITY AND MUTAGENICITY [70] "Formation of Tobacco Smoke-Induced Hemo- globin Adducts in Rats," C.G. Gairola, S.R. Myers, M.T. Pinorini-Godly, and S. Subramaniam, The Toxicologist30(1, Part 2): 6 [69] "Antioxidant Vitamins, Cancer, and Cardiovas- 503, 199 cular Disease," E.R. Greenberg and M.B. Sporn, "Hemoglobin adducts have been used as indicators of New EnglandJournal of Medicine 334: cumulative exposure to chemicals. Cigarette smoke, 1189-1190, 1996 "[S]cores of epidemiologic studies have noted a lower risk of cancer and cardiovascular disease among persons whose diets include a relatively large amount of vegetables and fruits.... Beta carotene has received particular attention as a disease-preventing antioxidant, with numerous favorable reports in scientific journals, and sales of supplements have soared....[T]here has been a persistent expectation that larger trials and longer periods of follow-up would ultimately demon- strate the benefits of beta carotene." which is a complex mixture of chemicals, can poten- tially generate electrophiles in vivo and interact with I _moglobin (Hb) to form a variety of adducts. The present study examined the formation of three Hb adducts in a rat model following experimental exposure to tobacco smoke. Sprague Dawley rats were exposed to sidestream cigarette smoke (SS-CS) for 6 hrs for 1 day or 6 hrs each day for 1 and 3 months in a whole body exposure chamber ... Three adducts, one formed by interaction of acrylonitrile with valine residues (AN-Val) and two formed by interaction of 4-aminobiphenyl (ABP-Cys) or benzo(a)pyrene SHB 93140343

MAY 10, 1996 (BP-Cys) with cysteine residues, were identified and measured ... Hb adducts could be detected evern after 1 day of exposure to SS-CS. Daily smoke exposure for 1 month increased the AN-Val, ABP-Cys and BP-tetrol-Cys adducts in exposed animals by about 2, 40 and 8-fold, respectively, in comparison to control levels ... These results support the use of Hb adducts as potential biomarkers of tobacco smoke exposure." [71] "Formation of 8-Hydroxy-2'-Deoxyguanosine in Heart, Liver, and Lung Tissue Due to Environ- mental Tobacco Smoke Exposure," D.J. Howard and C.A. Pritsos, The Toxicologist 30(1, Part 2): 357, 1996 "Environmental tobacco smoke (ETS) is a hotly debated social, political, and scientific issue; pitting smoker's rights against the health and safety of non-smokers. Striking an acceptable balance between the two depends largely on the potential health hazard assessment of ETS. Studies from this laboratory have shown that exposure to ETS contributes to oxidative stress in mouse heart, liver, and lung tissues. This study measures the level of oxidative damage to mouse liver, lung, and heart DNA as a result of this oxidative stress. Adult female Balb/c mice were exposed to a regimen consisting of seque.,ces of a 30 minute exposure followed by a 1.5 hour non-exposure, repeated up to 3 times. Tissues were excised following the exposure and non-exposure periods. DNA was then extracted from the tissues and analyzed for the presence of the oxida- tive product 8-hydroxy-2'-deoxyguanosine (8-OHdG). In all three tissues, the exposure increased the presence of 8-OHdG above the control levels. In some in- stances, the increased levels returned to normal by the end of the non-exposure period, while other tissues showed a further increase following non-exposure. These studies demonstrate that limited exposure to ETS produces measurable DNA oxidative damage." INDOOR AIR QUALITY A-19 [72] "The Impact of Heavy Metals from Environ- mental Tobacco Smoke on Indoor Air Quality as Determined by Compton Suppression Neutron Activation Analysis," S. Landsberger and D. Wu, The Science of the Total Bnviron- ment 173/174: 323-337, 1995 "The objective of this study is to improve neutron activation analysis (NAA) by using epithermal neutron irradiation and Compton suppression techniques for low level metal determination, and to monitor the concentrations of some heavy metals in public places, where ETS is present; for understanding its impact on indoor air quality." "[T]he detection limits of cadmium, arsenic and antimony measurement have been dramatically reduced to 2 ng for Cd, 0.2 ng for As and 0.05 ng for Sb." "Cadmium has been found as an important heavy metal in particulate phase of indoor air from smoking. Other heavy metals, such As, Sb and Zn are also found at elevated levels. Since these elements are classified as potentially toxic substances, long term inhalation of the metals, even at a low level, has a risk for respirable diseases. The accurate assessment of the risk is difficult to determine in a short period. Therefore, it is benefi- cial for general population to prohibit smoking in the indoor public places, or at least to separate smoking area and non-smoking area to decrease the risk of the passive smoking." [731 "Separating the Impact of Exposure and Person- ality in Annoyance Response to Environmental Stressors, Particularly Odors," G. Winneke, M. Neuf, and B. Steinheider, Environment Interna- tional22:73-81, 1996 "Experimental and field studies illustrate the impor- tance of person-related covariates in modulating annoyance responses to environmental stressors, particularly industrial odours. Experimental evidence is presented on trait-aspects of the annoyance-response, using traffic-noise, environmental tobacco-smoke (ETS), and odor (H,S) as controlled environmental stressors: Subjects preclassified as being high or low responders to either traffic noise or industrial odors in SHB

A-20 their everyday living environment exhibited similarly elevated or reduced reactivity to any of the stressors. Furthermore, field studies on exposure-response associations for odor-annoyance in the vicinity of odor-emitting industrial sources reveal that apart from age and perceived health general stress coping-styles modulate the degree of odor-annoyance: Problem-oriented coping activates and avoidance-coping reduces the expression of annoyance to environmental odours. It is concluded that transactions between person-related variables and environmental perceptions need to be considered for a better understanding of psychological responses to environmental stressors in general, and to environmental odors in particular." "In this paper, an effort is made by the authors to critically review certain experimental and epidemiologi- cal studies on annoyance by environmental stressors. Industrial odors are emphasized in order to demon- strate exposure response contingencies for environmental annoyance as well as their modification by person-related factors, namely trait annoyance, coping style, perceived health and age." SMOKING POLICIES AND RELATED ISSUES [74] "Cigarette Smoking in China: Prevalence, Characteristics, and Attitudes in Minhang District," Y.L. Gong, J.P. Koplan, W. Feng, C.H.C. Chen, P. Zheng, and J.R. Harris, Journal of the American Medical Association 274: 1232-1234, 1995 "In this study, we describe the prevalence, pattern, and familial financial implications of smoking and the attitudes toward and knowledge of the health effects of tobacco use in Minhang in 1993." "Of all 7016 male and female respondents, 6202 (88.4%) believed that smoking is harmful for the smoker and 6195 (88.3%) believed smoking is also harmful to those passively exposed to cigarette smoke." "A total of 332 (14.1%) of all 2279 male current smokers wished to quit smoking.... The most common reasons for wanting to quit were concern about their own health (72.4%), economic consider- ETS/IAQ REPORT, ISSUE 123 ations (27.6%)), objections of family members (12.9%), and concerns about the health of others (9.6%)." "This survey reveals a dangerous health situation that in all likelihood will worsen. More than two thirds of --males in Minhang District smoke, a rate comparable with those found in other parts of China (57% to 80%). People in successive age cohorts seem to start smoking at earlier ages. Young smokers prefer and more often smoke imported brands. Smokers are willing to spend a substantial proportion of their income on supporting their habit. There is a low rate -of quitting smoking and a low desire to quit despite high awareness of the detrimental health consequences of tobacco use. In addition, cigarettes sold in China rave higher tar content and are more likely to be unfiltered than those sold in the United States and thus present a greater health risk." "Future prospects could be even grimmer. Females, most of whom generate their own income, represent an untapped market for tobacco interests. Only 2% of females smoke in Minhang.... For the entire popula- tion of China, lung cancer rates are increasing by 4.5% per year." Beyond the personal economic costs of smoking, in China as well as the United States, tobacco as a profitable crop and commodity creates a conflict of interest for a government also responsible for improv- ing its people's health." "Warnings have been issued previously in the medical literature on the health crisis in China due to tobacco use, and some reassurance has been found in regula- tions imposing controts and restrictions on the tobacco industry. However, the warnings have provoked little organized local governmental or international action, and the regulations have been inconsistently enforced." [75] "Resident Smoking in Long-Term Care Facili- ties -- Policies and Ethics," G. Kochersberger and E.C. Clipp, Public Health Reports III: 66-70, 1996 "Concerns about the quality of care for the 1.5 million nursing home residents in this country led to the nursing home reform measures contained in the _ Omnibus Budget Reconciliation Act of 1987. Promo- tion of nursing home residents' rights, including SHB 93140346

MAY 10, 1996 `accommodations of individual needs and preferences,' was an integral part of that legislation. Nursing homes are no different from society as a whole in balancing issues of personal autonomy and the rights of others as they relate to cigarette smoking. In fact, the close living proximity and restricted mobility of must nursing home residents accentuate these conflicts. When smoking is permitted, nonsmoking staff and residents are exposed to secondhand smoke. Also, residents with cognitive impairment and various physical disabilities are often unsafe smokers and present safety risks to themselves and others." "We ... conducted a national survey of Department of Veterans Affairs (VA) Nursing Home Care Units to collect information on the number of smokers among long-term care residents and the problems arising from allowing patients to smoke." "[I] n the facilities for which we received reports, approximately one-quarter (22%) of the residents were reported to be smokers. All responding facilities accommodated smokers. Seventy-six percent had a designated smoking area connected with the nursing home; smokers in the remaining facilities utilized areas designated for smoking for the entire medical center population. Over half (61%) of the nursing home smoking areas were indoors, and the remainder were reported as being separate structures outside the nursing home, for example, a patio. Most administra- tors (91%) reported that residents were never allowed to smoke in their rooms, with 9% of the facilities `seldom or occasionally' allowing this practice." "Most nursing home supervisors ranked patient safety (the risk of fire) as a`major concern.' Seventy-eight percent of respondents ranked health effects to the smokers themselves a`major concern,' while 70% put health effects of smoking to exposed nonsmokers in that category. Less than half (46%) considered damage to the smoking area (burns in rugs and furniture) of major concern. To a follow-up question, 'Should nursing homes provide a designated indoor smoking areas?' 43.7% of respondents answered yes." "The exposure of nonsmokers to passive or 'second- hand' smoke led to at least occasional complaints in 62% of facilities. Frequent complaints were reported in 23% of responding facilities. Smoking areas in nursing homes are often situated so that it is logistically impossible to protect nonsmokers from smoke expo- A-21 sure. Fifty-three percent of respondents reported that nonsmokers as well as smokers use smoking areas in their fucilities. Of the 47 facilities with ir.door smoking areas, 38 (76%) used exhaust fans to vent smoke directly to the outside. Most nursing homes with such an arrangement (95%) reported these fans to be somewhat effective (62% noting them to be moder- ately or very effective), but the differences between the number of complaints in facilities with and without ventilation fans were not statistically significant." "The majority (91%) of the chief nurses or unit supervisors responding to the survey did not smoke themselves. However, there were differences between these smokers and nonsmokers in the concerns they expressed about smoking behavior. For example, a greater proportion of the nonsmokers (95%) than smokers (78%) expressed concern about exposure of nonsmokers to smoke. VA policy continues to allow smoking in nursing homes 'except when patients are a danger to themselves.' Interestingly, the majority (67%) of the respondents reported seeing smoking as a`privilege,' while 59% felt that smoking was a`right' for their patients. Some respondents reported that smoking is both a right and a privilege. Several explained this apparent contradiction by noting that administrative and personal views were at odds on this matter." "The adverse effects of exposure to passive smoke have received increasing attention and have been the impetus behind indoor smoking bans in many public facilities and healthcare institutions. VA policy, which established smoke-free hospitals in 1991, has recently been made less stringent by controversial federal legislation. Smoking bans on hospitalized patients may be viewed as paternalistic acts, but it is believed that the resulting inconvenience is temporary and offset by improved health for deprived smokers and those around them. Clearly, a smoking ban on long-term care residents would be more difficult to impose. The hospitalized smoker, denied his or her cigarettes, will return home in a week or two, free to exercise self determination which may include a resumption of smoking. The nursing home resident is rarely dis- charged to another `home,' making the smoking ban a lifelong imposition." SHB

A-22 STATISTICS AND RISK ASSESSA•fENT [76] "Who's Exaggerating?" A.M. Finkel, Discover May: 48-51, 54, 1996 "Quantitative risk assessment, or QRA, tries to l;ive policymakers the information they need to answer ... questions in a rational way. It tries to determine how many people are likely to get sick or die as a result of a particular hazard, and how much it would cost to save at least some of them." "[T]he version of QRA that many in Congress, academia, and the media have embraced is a repudia- tion of much of what has gone before iri this field. It is reform premised on a myth -- namely, the myth that current assessment methods routinely exaggerate risk, at a huge cost to society. To my mind, risk assessment is in danger of being subverted just as it is coming into its own as a scientific discipline." "Producing either `best' or `most plausible' estimates of risk sounds like a commonsense goal. But is it really? To decide, you need to answer two questions that critics of current QRA tend to duck. First, what is the evidence.. . that risk estimates today are routinely skewed in an overly conservative way? Second, if risk estimates really are skewed, is that a serious social problem and one for which 'best' estimates are the cure?" "Tackling the second question first, let's think about what it would mean to protect the 'average person' from the 'average risk.' Most individuals are not average as far as risks are concerned; they vary greatly in their exposure and susceptibility to pollution, just as they vary in, say, body weight.... If we design our regulations to protect the average person, risk asses- sors reason, we may fail to adequately protect large segments of the population. Would that really be 'good science'?" "Then there is the question of what it would mean to estimate an 'average risk.' All estimates of risk involve uncertainry....[Y]ou can never get a single definite number; if you're honest with yourself, you'll get a range of answers. Picking the average value of that range is no more scientific than any other choice; all choices are value judgments in that they strike some balance between the health and economic costs of underestimating the risk and the costs of overestimat- ETS/IAQ REPnRT, ISSUE 123 ing it. Choosing the average, as 'unbiased' as that may sound, merely implies that those costs are exactly equal which is a strong bias indeed." "Risk assessors traditionally set their sights on the 'reasonable worst case' -- that is, they try to give themselves more than an even chance of overestimating the risk in order to be reasonably sure they won't underestimate it." "If instead of averaging the various risk estimates we simply pick the 'most plausible' among them, we may be even worse off. How do we decide which of. two or more plausible but competing scientific theories is most plausible? By some kind of majority vote among experts?" "So much for the idea that 'best' estimates would naturally lead to 'objective' or commonsense regula- tions. But the great irony of the current debate is the surprising lack of credible evidence that today's risk assessments do in fact tend to be overly conservative." "To be sure, risk assessors do make assumptions that tend to exaggerate risk. For example, they usually assume that subjects are exposed to a suspected car- cinogen 24 hours a day instead of, say, 8. The pending 1P,islation would allow court challences to any regula- tion that uses that assumption, on the grounds that it typically introduces a threefold over-estimate of __ exposure. But dozens of assumptions go into a risk assessment, and critics tend to ignore the ones that cut in the opposite direction." "All in all, no one has yet succeeded in finding a systematic bias in current risk assessment procedures, apart from the desire -- not always fulfilled -- to protect nonaverage people." "To make sensible cost-benefit decisions, obviously, you need to know the costs as well as the benefits of the action you're contemplating. The legislation Congress is now considering prescribes dozens of rules for risk assessment without mentioning problems of cost analysis at all. But figuring out the true cost to the economy of health and environmental regulations is as hard and as fraught with uncertainty as risk assessment itself. And the evidence that•costs are routinely exaggerated is in fact far stronger than the evidence that risks are." SHB 93140347

MAY 10, 1996 "For all these reasons, the direct costs of regulations tend to be overestimated when they are first imposed." "[W]e should not ask of risk assessment more_quan- tity or quality than it can yet deliver. Above all, we should not pretend we are promoting 'good science' when we are really pushing a political ideology -- one that says less government regulation, at least where health and the environment are concerned, is always better than more. It is not that there is anything wrong with value judgments; risk assessment cannot be done without them. It is just that those value judgments should be made explicit and not be allowed to mas- querade as objectivity. Here are my values, the ones that got me into this business in the first place: I believe that risk assessment, as it is now practiced and as it is steadily being improved, can help us protect health and the environment more cheaply and efficiently and prevent unnecessary injuries, illnesses, and deaths. And I believe that whatever society decides about how much it is worth to save a life or protect an ecosystem, the real 'best' risk assessment is one that encourages decision makers to be honest about uncertainty and to make smart -- and humane -- responses to it." SHB

MAY 10, 1996 APPENDIX B UPCOMING SCIENTIFIC MEETINGS • May 10-15, 1996 American Thoracic Society/American Lung Associa- tion 1996 International Conference, Morial Convention Center, New Orleans, Louisiana [Issue 116 item 41] • May 16, 1996 Frontiers in Genetic Toxicology, Hotel Dupont, Wilmington, Delaware, May 16, 1996 [Issue 121 item 46] • May 18-24, 1996 1996 American Industrial Hygiene Conference & Exposition, Washington Convention Center, Wash- ington, D.C. [Issue 119 item 40] • May 19-22, 1996 Fourth International Symposium on Metal Ions in Biology and Medicine, Tarragona, Spain [Issue 119 item 41 ] 9 May 20-21, 1996 Harmonization of State/Federal Approaches to Environmental Risk, Kellogg Center, Michigan State University, East Lansing, Michigan [Issue 118 item 47] • May 20-22, 1996 Issues and Answers to Indoor Air Quality, Falls Church, Virginia [Issue 119 item 37] • June 10-July 5, 1996 New England Epidemiology Summer Program, Boston, Massachusetts [Issue 119 item 42] • June 12-15, 1996 Society for Epidemiologic Research Annual Meeting, Park Plaza Hotel, Boston, Massachusetts [in this issue] • June 20-28, 1996 Air & Waste Management Association 89th Annual Meeting and Exhibition, Nashville, Tennessee [Issue 109 item 28] 9 June 22-26, 1996 ASHRAE Annual Meeting, Marriott River Center, San Antonio, Texas [in this issue] B=1 • July 7-11, 1996 Indoor Air Quality: A Critical Evaluation of the Science and the Art, Johnson State College, Johnson, Vermont [Issue 120 item 35] • July 8-12, 1996 Annual Summer Toxicology Forum, Given Biomedical Institute, Aspen, Colorado [in this issue] • July 17-19, 1996 5th International Conference on Air Distribution in Rooms, Room Vent '96, Yokohama, Japan [Issue 100 item 28] • July 21-26, 1996 Indoor Air '96: The 7th International Conference on Indoor Air Quality and Climate, Nagoya, Japan [Issue 82 item 29] • August 5-9, 1996 Toxicology for the 21st Century, Plaza San Antonio Hotel, San Antonio, Texas [Issue 122 item 39] • August 12-16, 1996 Occupational and Environmental Radiation Protec- tion, Harvard School of Public Health, Boston, Massachusetts [Issue 122 item 40] • August 26-30, 1996 3rd International Course on Sick Building Syndrome in the Office Environment--Measurements and Evaluation, Schaeffergaarden, Copenhagen, Denmark [Issue 112 item 41] • August 26-30, 1996 Inhaled Human Particles VIII: Occupational and Environmental Implications for Human Health, Robinson College, Cambridge, England [Issue 117 item 50] • August 27-30, 1996 The 14th International Scientific Meeting of the International Epidemiological Association: Global Health in a Changing Environment, Nagoya Congress Center, Nagoya, Japan [Issue 121 item 47] SHB

B-2 ETS/IAQ REPORT, ISSUE 123 • September 15-18, 1996 Sixth International Meeting on the Toxicology of Natural and Manmade Fibrous and Non-Fibrous Particles, Hilton Hotel, Lake Placid, New York [Issue 120 item 36] • September 15-20, 1996 25th International Congress on Occupational Health, Stockholm International Fairs, Stockholm, Sweden [Issue 115 item 32] • September 16-18, 1996 The Ninth Annual National Conference on Indoor Air Pollution, Hotel Royal Plaza, Orlando, Florida, September 16-18, 1996 [Issue 121 item 48] • September 16-20, 1996 13th Inte-national Symposium on Contamination Control, The Hague, Netherlands [in this issue] • September 20-22, 1996 Ist International Course on Risk Assessment of Carcinogens, Silja Serenade, Stockholm, Sweden [Issue 113 item 54] • October 6-8, 1996 IAQ'96: Paths to Better Building Environments, Baltimore, Maryland [Issue 110 item 39] • October 6-9, 1996 Carcinogenesis from Environmental Pollution: Assess- ment of Human Risk and Strategies for Prevention, Hotel Gellert, Budapest, Hungary [Issue 120 item 37] • August 24-28, 1997 10th World Conference on Tobacco or Health, Beijing International Convention Center, Beijing, China [Issue 122 item 41] SHB