Latest news with #epidemiology
Irish Times
5 days ago
- Health
- Irish Times
Mike Ryan: What next for the ‘Indiana Jones of epidemiology' as he leaves WHO?
If Indiana Jones had been an epidemiologist instead of an archaeologist, Hollywood might have looked no further for inspiration than the life and times of a Co Sligo man, Mike Ryan . The 60-year-old is leaving the crisis-hit World Health Organisation (WHO) after decades of fighting deadly diseases in some of the most dangerous places on earth. In January, a week after President Donald Trump signed an executive order pulling the US out of the WHO, Ryan, the organisation's deputy director general, was doing what he does best. He was on his way to check out the response to an Ebola outbreak in Kampala, Uganda, after giving a pep talk in Islamabad to the team trying to eradicate polio in Pakistan and Afghanistan, the last two countries where it remains stubbornly endemic. READ MORE WHO director general, Tedros Adhanom Ghebreyesus , who visited Dublin this week, says the world is 'living in a golden age of disease elimination' and his one-time right-hand man, Ryan, has been at the forefront of that effort since he joined the organisation in 1996. Tedros paid tribute to Ryan on Friday at a press conference in WHO's Geneva HQ on the inconclusive findings of an advisory group assessing the origins of the Covid virus. 'I know that many of you value his experience and knowledge and his Irish way of saying things. WHO will not be the same without Mike but when he says I am tired and need to go then it is very difficult to keep him,' he said. Tedros with help on pronunciation from Dr Ryan managed to say: 'Go raibh mile maith agat.' 'It's been a long road,' Ryan responded. 'Eight years leading the emergencies programme and I can tell you it's a 24-hour 365 day job and it's been a great honour Tedros to lead it on your behalf and on behalf of all our wonderful staff and partners and people out there on the front lines.' His leading role in the WHO's efforts during the Covid-19 pandemic earned him a Presidential Services Award from Michael D Higgins, and he takes pleasure in the fact that Tom Howley's, his local pub in Curry, Co Sligo, displays a newspaper headline announcing that he shared the honour with Jack Charlton. Dr Mike Ryan and is team in North Kivu, Democratic Republic of Congo The young Mike Ryan lost his merchant seaman father at the age of 11 and was raised by his mother along with his two brothers in a family that extends across the border into Co Mayo. He played GAA football up to senior level for Curry, and it's a place he loves to return to when he can. Ryan was the first in his family to go to university. While completing his studies to be a trauma surgeon, he took a job in a hospital in Baghdad, Iraq, and was held hostage there by Saddam Hussein's regime during the first Gulf War. He worked to the point of exhaustion. [ How Dr Mike Ryan became a victim of 'desperate' funding crisis in WHO Opens in new window ] Before his release from Iraq, he fractured his spine in a road incident, which ended his ambition of becoming a surgeon but launched him into what became a distinguished career as an epidemiologist. 'He's the complete package,' says a long-time colleague, Bruce Aylward, a Canadian epidemiologist who also leaves the WHO senior management team this month as major cutbacks get under way. Canadian epidemiologist Bruce Aylward: 'Mike [Ryan] is one of those rare people who can step into those spaces, command respect and chart a way forward. He brings wonderful clarity of vision.' Photograph: Fabrice Coffrini/AFP/Getty Images. 'There's no denying what a giant Mike is in global health and especially in the world of infectious diseases and emergencies. He has been on the front end of so many of these now, so competent. Mike is one of those rare people who can step into those spaces, command respect and chart a way forward. He brings wonderful clarity of vision. At the same time, he's a man of the people who can lead a team in the midst of uncertainty,' adds Aylward. Only time will tell where Dr Ryan goes next. Could it be Áras an Uachtaráin? Head of the HSE? A senior UN role? A return to the WHO as a senior adviser? Or, could he lead a mooted pandemic corps of international health experts to boost preparedness for the next pandemic, possibly funded by Bill Gates? [ Dr Mike Ryan targeted by political parties for potential presidential run Opens in new window ] Could Labour or another political party recruit him as a candidate for the autumn's presidential campaign. His interest in joining the Department of Health has been sounded out, unsuccessfully, before. On the prospect of a run for the presidency, Mary Harney, the former minister for health, said: 'He's a man of enormous substance and highly rated across the globe. I think he would be a very formidable candidate. He's got a lot of street cred especially after his defence of the children of Gaza. I couldn't speak highly enough of him.' Ryan's diplomatic skills are in no doubt following the adoption by UN member states at the World Health Assembly last month of a global pandemic agreement. Following the Covid pandemic, which claimed some 20 million lives, Ryan said: 'The prospect of facing the next big pandemic without some common agreement between states seems unconscionable.' The agreement is a rare example in the current geopolitical climate of a multilateral success for the UN system. It provides a template for future pandemic response and international co-operation, though it still requires a further annex to be adopted at next year's World Health Assembly before it can be fully ratified. Mike Ryan's ability to nurture organisational sea change was first demonstrated 25 years ago when he conceived the idea of a Global Outbreak Alert and Response Network, which today numbers 310 institutions, including national public health agencies and NGOs Exasperated by suggestions that the WHO was a 'deep state'-type agency, Ryan pointed out that the word 'lockdown' does not feature in the text and has likened the role of the WHO to that of the staff at Augusta, home of the US Masters golf tournament. 'We get to cut the greens and serve the sandwiches,' he says. Following its adoption by consensus at the World Health Assembly, Tedros paid tribute to Ryan and his deputy, Jaouad Mahjour, for their tireless support to the International Negotiating Body over the last 3½ years of discussion and drafting. This singular achievement marks Ryan out as someone with the strategic nous to help the UN reinvent itself as it faces into an existential crisis forced by UN member states demanding a reduction in the plethora of UN bodies and mandates as they follow the US example and slash development and humanitarian aid budgets. His ability to nurture organisational sea change was first demonstrated 25 years ago. He then conceived the idea of a Global Outbreak Alert and Response Network, which today numbers 310 institutions, including national public health agencies and NGOs. It has been activated in more than 150 international outbreak responses, dramatically curtailing the spread of infectious diseases and reducing epidemic death tolls. There is a possibility that the UN may turn to Ryan as it seeks to devise a new global health architecture that will break down the silos between UN agencies providing health services to people affected by conflict and disaster. These include Unicef, the children's agency, UNHCR, the refugees agency, and the World Food Programme. Under one option outlined in a recent leaked memo from UN headquarters in New York, operational aspects of these agencies could be merged into a single humanitarian entity. At the same time, the WHO is in discussion with 12 sister agencies and global health initiatives to see how synergies and savings can be made. Ryan has a phenomenal appetite for work. As evidenced by his January visit to Pakistan, he temporarily filled the vacuum left by the untimely death last August of his good friend and colleague, ex-Irish army officer Aidan O'Leary, who was the WHO director of the global polio eradication initiative. [ Aidan O'Leary obituary: Humanitarian who led WHO's polio eradication efforts Opens in new window ] He also led the prioritisation exercise forced on the WHO by budget cuts that are likely to see a 25 per cent cut in staff numbers at its Geneva base and across regional offices, as it faces a shortfall of $1.7 billion in its running costs of $4.2 billion over the next two years. The initial reduction was top-down, reducing the senior management team from 14 to seven, and work got under way in earnest this week to cut the number of department heads from 76 to 34 before a wider cull of staff gets under way. In his parting words on Friday, Dr Tedros told Dr Ryan 'we know where to find you' in a hint that there may yet be work for him to carry out on behalf of the WHO. It was clear in Tedros's initial announcement last month that it was not easy to let him go. 'The new team has been chosen after very careful consideration, and to ensure gender balance and geographical representation,' Tedros said. 'This was, as you can imagine, an extremely difficult and painful decision for me, as it is for every manager in our organisation who is having to decide who stays and who goes.' [ World Health Organisation forges ahead as US makes its absence felt Opens in new window ] Whatever the calculation that resulted in his departure, there is little doubt the WHO has lost one of its finest advocates and best communicators, someone who reassured the world at large that professionals were in charge during the constant rounds of media briefings at the height of the pandemic. Ryan could also engage listeners when he talked about a humanitarian crisis such as the killing and starvation of Palestinians by Israel. He spoke from the heart last month when addressing the UN Geneva press corps on the horrific situation in Gaza. 'We are breaking the bodies and the minds of the children of Gaza. We are starving the children of Gaza because if we don't do something about it, we are complicit in what is happening before our very eyes.' Ryan is a man for all seasons, and it is hard to imagine we have seen or heard the last of him.
The Guardian
5 days ago
- Business
- The Guardian
Inside a plan to use AI to amplify doubts about the dangers of pollutants
An industry-backed researcher who has forged a career sowing doubt about the dangers of pollutants is attempting to use artificial intelligence (AI) to amplify his perspective. Louis Anthony 'Tony' Cox Jr, a Denver-based risk analyst and former Trump adviser who once reportedly claimed there is no proof that cleaning air saves lives, is developing an AI application to scan academic research for what he sees as the false conflation of correlation with causation. Cox has described the project as an attempt to weed 'propaganda' out of epidemiological research and perform 'critical thinking at scale' in emails to industry researchers, which were obtained via Freedom of Information Act requests by the Energy and Policy Institute, a non-profit advocacy group, and exclusively reviewed by the Guardian. He has long leveled accusations of flimsiness at research linking exposure to chemical compounds with health dangers, including on behalf of polluting interests such as cigarette manufacturer Philip Morris USA and the American Petroleum Institute – a fossil fuel lobbying group he has even allowed to 'copy edit' his findings. (Cox says the edit 'amounted to suggesting a small change' and noted that he has also obtained public research funding.) Both the tobacco and oil industries have a history of weaponizing scientific uncertainty, experts say, with some arguing that similar tactics drive the Trump administration's current deregulatory efforts. The president's May 'gold standard' science order, for instance, empowered his appointees to 'correct scientific information' and 'discipline' those who breach the administration's views, prompting outrage from some scientists. Cox has obtained funding to develop the new AI reviewer from the American Chemistry Council (ACC), the nation's largest chemical industry advocacy group, which counts oil and chemical giants such as Exxon and DuPont as members. Experts say the ACC's sponsorship raises questions about whom the project will benefit. Asked about these concerns, Kelly Montes de Oca, spokesperson for the ACC, said: 'This research has the potential to support scientific understanding and analysis of chemical exposure and human health, enhance transparency and reproducibility, advance the safety of chemical products and processes, and inform science-based global regulatory approaches.' Cox said in an email to the Guardian that his assistant 'is specifically designed to be helpful to those who wish to understand the objective implications of data without any distortions from the kinds of well-known human heuristics and biases that make objective analysis difficult for humans'. 'My work aims to help anyone interested in using sound technical methods to pursue scientific truth,' he added. The questions sent to him by the Guardian contained 'many fundamental inaccuracies', he said. Cox said the tool is currently being tested on submissions to academic journals – including Risk Analysis, which he edits – to evaluate research submissions before they are submitted to the peer review process. Asked for a response to concerns about the project's funding, Cox said that he has publicly acknowledged the ACC's support in all relevant publications and said the tool 'has no axe to grind and no positions to push'. But the ACC is not a neutral force, said Chris Frey, the associate dean for research and infrastructure at the North Carolina State University's College of Engineering who chaired the Environmental Protection Agency's clean air scientific advisory committee from 2012 to 2015. 'They lack impartiality in that they want to minimize regulatory burden on their members,' said Frey. In mid-February of 2023, Cox struck up a conversation with the AI assistant ChatGPT. He later sent the chat to his University of Colorado email address, which is subject to public record request laws. After asking the chatbot to write a sonnet about Abraham Lincoln, he turned the conversation to a more serious topic: the tiny toxic particles known as PM2.5, also known as fine particulate matter. Scientists have long found links between PM2.5 exposure and a wide variety of health concerns, from asthma and lung disease to heart attacks. But for years, Cox has raised uncertainty about those connections, publishing work 're-assessing' the mortality risks associated with exposure to the pollutant in animal agriculture and challenging the link between PM2.5 from gas stoves and childhood asthma. On that February day, Cox asked ChatGPT a simple question: 'Does PM2.5 cause lung cancer?' The bot responded by noting the 'strong scientific evidence' demonstrating the link. A seemingly dissatisfied Cox went on to ask if it is 'known with certainty that PM2.5 causes lung cancer', calling on ChatGPT to identify potential confounding factors in the research on the air pollutant. He took brief tangents to pose riddles to the bot and to request additional sonnets – including one about PM2.5 itself, yielding the line 'no nose can catch you, for you are so fine'. Eventually, Cox asked ChatGPT whether the association between PM2.5 and lung cancer can be explained by a 'combination of residual confounding, measurement errors, and modeling biases'. The bot maintained that 'the observed association is likely to be real and not fully explained by these factors'. From a conversation Cox had with ChatGPT in February 2023 Write a sonnet about PM2.5 and lung cancer Oh, deadly PM2.5 in the air, So small and yet so full of poison's might, A silent killer that we cannot bear, You infiltrate our lungs both day and night At the time of the conversation, Cox had already been interested for years in making 'smarter and more trustworthy AI', he told the Guardian. He had published a paper on the topic in 2021, and the following year – months before ChatGPT's release – had begun developing his own AI tool. The ACC had partly funded that work, he said. Cox also had a meeting with the Long-Range Research Initiative, a lobbying group focused on 'innovations in chemical safety science' which includes Exxon, just hours before he had the February 2023 ChatGPT conversation, the emails show. In an email seeking funding to develop an AI tool, Cox seemingly referenced that 'long experimental chat'. Among the recipients were George Maldonado, the editor of the academic journal Global Epidemiology, and ACC toxicologist Rick Becker. Cox wrote in the email that his questions eventually led ChatGPT to 'concede that we don't actually know that PM2.5 at current ambient levels causes lung cancer in humans – but it was a struggle to get there!' The chatbot 'does an excellent job of reflecting the 'party line' that is most prevalent on the web, fallacies and all', Cox continued in the email. But new AI software could be used to do ''critical thinking at scale' (if I may be grandiose!)', he said. The following day, Cox emailed a larger group of researchers, including Becker and two ExxonMobil scientists. ChatGPT, he wrote, 'seems to me to display a very strong starting bias that can eventually be overcome by sufficiently patient questioning'. That bias involved conflating 'evidence of association with evidence of causation', he said. From an email Cox sent to industry researchers in February 2023 We can help bend applications of this technology toward scaled-up critical thinking instead of scaled-up groupthink and propaganda 'I am hoping to build a critical mass of interest and get some funding in this area so that we can help bend applications of this technology toward scaled-up critical thinking instead of scaled-up groupthink and propaganda,' he added. Cox's past work may shed light on the 'groupthink and propaganda' that his work questions. In one 2023 study he co-authored, he found that exposure to the 'forever chemical' known as PFOA can occur in safe doses. The research was conducted with the organization Toxicology Excellence for Risk Assessment, headed by the contentious toxicologist Michael Dourson, who has also received funding from chemical makers. Another study the same year, which Cox co-authored with a Chevron toxicologist, said molybdenum – a petrochemical present in lubricants Chevron produces – was 'not a risk factor for changes in serum testosterone'. And in a third 2023 study, Cox said his research found no link between childhood asthma and gas stove exposure. At a 2018 conference, Cox also claimed there is no proven connection between air pollution and respiratory problems or heart attacks, while he said in a 2012 paper – funded in part by tobacco company Philip Morris USA – that he found smoking half a pack of cigarettes daily did 'not appear to be associated' with increased risk of coronary heart disease. In an email to the Guardian, Cox said the methods he applies are 'drawn from the scientific mainstream – not from ideology or partisanship'. 'Some critics have mischaracterized my work as an attempt to delay regulation or promote industry interests. That is not true,' he said. 'I do not advocate for or against any policy outcome. I advocate for grounding decisions in empirically supported causal understanding.' Cox served as an adviser to policymakers in his role on an EPA advisory committee. He has also argued against the proposed tightening of a regulation at an Occupational Safety and Health Administration hearing, in his capacity as an ACC consultant. Adam Finkel, a risk analyst and environmental health sciences professor at the University of Michigan, said though he believes Cox to be in some ways a 'genius' and skilled risk analyst, he also seems to be 'deceiving himself and everyone else' about the impacts of bias on his research. 'How you interpret any information is by imposing your preferences,' said Finkel, who is also a former director of health standards programs at the US Department of Labor's Occupational Safety and Health Administration. 'There is no possible way to get around imposing some set of preferences.' Some degree of uncertainty is inherent to scientific analysis. But when assessing whether or not there is a causal effect between exposure to something potentially harmful, Finkel said, Cox looks for 'perfect certainty', which 'can lead to years and decades of doing nothing and harming people while you wait for the certainty to come'. While Finkel has 'fundamental belief that our system is under-protective' when it comes to public health, Cox seems to believe the opposite. Asked for comment, Cox said: 'I have never advocated that we should not act until we have certainty. Rather, I have advocated choosing to act on the best available information.' He said his work has acknowledged causal relationships between smoking and lung cancer, asbestos exposure and mesothelioma, and, in 2011, crystalline silica exposure and lung disease. But at the Occupational Safety and Health Administration hearing at which he spoke in 2014, Cox asserted on behalf of the ACC that the federal government had not demonstrated a link between certain levels of silica exposure and lung disease. 'He'll accept that at very high doses, this stuff is bad for you,' said Finkel. Policy is meant to ensure that level of exposure doesn't occur, he added. Maldonado, editor of Global Epidemiology, responded positively to Cox's AI assistant proposal, the emails from 2023 show. Within weeks, his journal published another one of Cox's conversations with ChatGPT in his journal. 'The purpose of this comment is to provide an example of a Socratic dialogue with ChatGPT about the causal interpretation of an important epidemiological association between exposure to fine particulate matter air pollution (PM2.5) and mortality risk,' says the paper, which states that it was partly funded by the ACC and counted climate denier Steve Milloy as one of its reviewers. When the bot said 'it is well-established that exposure to ambient levels of PM2.5 does increase mortality risk', Cox accused it of confusing evidence of association with evidence of causation. Eventually, ChatGPT said: 'It is not known with certainty that current ambient levels of PM2.5 increase mortality risk.' But the distinction between correlation and causation is 'epidemiology 101', said Gretchen Goldman, president of the scientific advocacy group Union of Concerned Scientists, who co-authored a 2019 paper critiquing Cox. 'From day one of a study, researchers consider, analyze and guard against possible confounding factors,' said Goldman. 'This uncertainty is always present, but that of course doesn't mean the research is wrong.' Demonstrating clear causal links between pollutants and health impacts can be complicated, especially because unlike in testing pharmaceuticals, it can be difficult and unethical to establish control groups for comparison. 'If you're looking at the effects on an actual population that's been exposed in real life to pollutants, you can't do those controlled types of studies,' said Frey of North Carolina State University's College of Engineering. 'That leads to thinking about ways to make inferences from real world data that might, for example, mimic a random, controlled trial.' But though demonstrating true causality can be complex, Cox has long overstated scientific uncertainty while downplaying evidence, said Frey. 'Science denialism often sounds convincing because it contains some truthiness to it or elements of truth or elements of valid points, but it's often based on either overemphasis or omission and doesn't portray a full picture,' he said. As chair of EPA's clean air scientific advisory committee during Trump's first presidential term, for instance, Cox proposed eliminating all research from the agency's consideration that did not demonstrate 'manipulative causation', wherein intervention on one variable would change the probability of an outcome. 'I see it as being about using widely accepted, non-controversial principles of causal analysis and inference,' Cox said of his push for this change. But in effect, the alteration would have dramatically and unnecessarily 'winnowed down' the body of evidence to which the EPA could have referred and removed research from consideration which 'in fact robustly' demonstrates that certain compounds cause harm, Frey said. 'That effort and his work generally have not been viewed as compelling by the mainstream scientific community,' he added. Industry interests have promoted uncertainty to defend their business models, Frey said. The oil sector, for instance, had strong evidence that fossil fuels warmed the planet as early as the 1950s yet publicly called the link 'weak' or even 'non-existent' for decades. Cigarette manufacturers also long promoted the idea that the connection between cigarettes and health harms was tenuous, with one tobacco executive even saying in 1969 that 'doubt is our product'. 'It's a well-worn tactic,' said Frey. Cox kept corresponding with industry scientists about his new tool, all the while holding similar conversations with ChatGPT about causation in research. In May 2023, for instance, Cox posed questions about the causal claims in a recent landmark study linking gas stove exposure to childhood asthma, the emails show. Later that month, Cox sent a slideshow to the ACC's Becker and several other industry-related scientists. His reviewer, it showed, had identified issues with the recent gas stoves study, and another major assessment which linked PM2.5 exposure to cardiovascular issues. This tool could 'benefit authors, reviewers, reporters, media (if we make the summary reports good enough), and decision-makers and policymakers trying to evaluate studies and decide how trustworthy their methods and conclusions are', Cox said. In a proposal sent days later, he added that it is 'probably good enough to be commercially useful'. In July 2023, Cox presented his new tool to members of the Long-Range Research Initiative – which also funded his earlier work – including to representatives from Exxon. Ahead of the meeting, Cox sent the group a conversation he had with the reviewer, which used a 2020 paper demonstrating a causal link between PM2.5 and mortality as an example of the kind of conflation his tool could spot. Maldonado, the editor of Global Epidemiology, offered to give the tool a 'friendly trial' at his journal. From an email Cox sent to the American Chemistry Council's Becker in July 2023 Such automated critical reasoning can help to thoroughly review, and potentially to improve, the scientific claims and scientific integrity of causal reasoning and presentation of evidence underlying many regulatory risk assessments After the meeting, Cox sent a two-part project proposal to the ACC. 'Such automated critical reasoning can help to thoroughly review, and potentially to improve, the scientific claims and scientific integrity of causal reasoning and presentation of evidence underlying many regulatory risk assessments,' Cox said. For part one, an academic paper on the project which would be published in Maldonado's Global Epidemiology, he asked for $75,000. For part two, a pilot testing the reviewer on submissions to the same journal, he asked for $80,000. In his response to questions from the Guardian, Cox confirmed the ACC's funding but not a dollar amount. Cox published the 'phase 1' paper about his new AI reviewer in the journal Global Epidemiology in June 2024. He also appears to have secured $40,000 for Global Epidemiology to participate in the second phase, but the partnership 'did not come to fruition' because too few authors were willing to participate, Cox told the Guardian. Maldonado did not respond to a request for comment. By April 2024, Cox told the ACC's Becker in an email that his reviewer tool was 'ready for a demo', claiming its reviews are 'already better than many human reviews, although not as on-point and insightful as the best human reviews'. But in an email last May to toxicologist Ted Simon, Cox said 'the real goal' of the tool was to enable it to do literature reviews, examining wide swaths of published information in a particular subject area. That month, ExxonMobil scientist Hua Qian ran a test of the tool. Now, Cox told the Guardian, the tool was being tested by researchers submitting work to the journal he edits, Risk Analysis, and other academic journals, including Decision Analysis. About 400 people have tested the tool so far. Itai Vardi, a manager at the Energy and Policy Institute, who shared the trove of emails with the Guardian, said the project could have disastrous consequences for academia, particularly epidemiology. 'AI language models are not programmed, but built and trained,' he said, 'and when in the hands and funding of this industry, can be dangerous as they will further erode public trust and understanding of this crucial science.' Asked about critics' concerns about the ACC's funding for the project, Cox said: 'People who are concerned about the use of sound science in areas where politics has dominated might understandably be concerned about the use of such tools.' But people should 'favor the development' of the AI tool if they want to 'apply sound science to improve our understanding of the world and how to act more effectively', he said. 'The fact that the ACC … are starting to step up to the challenge of designing AI to increase the objectivity, transparency, and trustworthiness of scientific research seems to me to be a great public benefit,' he said. But the ACC 'cannot be trusted as a source of 'objectivity, transparency, and trustworthiness of scientific research',' said Frey, when that research is 'aimed at understanding the human health harms caused by chemicals manufactured by their members'. And for him, Cox's use of the term 'sound science' also prompted concern. ''Sound science' is a term popularized by the tobacco industry as part of a campaign to create burdens of proof far beyond those required for policy decisions,' Frey said. Indeed, in the 1990s, Philip Morris USA – for whom Cox has done research – ran a 10-year 'sound science' public relations campaign to sow doubt about the harm cigarettes cause. In an email to the Guardian, Cox noted that 'reputable scientists' use the term to refer to reliable, verifiable research that follows accepted scientific methods. He dismissed the idea that causation can be difficult to prove in epidemiology. 'My response to people who are concerned that we should treat evidence of repeated associations as if it were evidence of interventional causality is that this outdated style of thinking is tremendously harmful and counterproductive in designing effective measures to successfully protect human health and safety,' he said. Asked for examples of harmful policies created by overreliance on association, Cox named several scientific studies, including a 1996 experiment which was stopped because interventions that were expected to slash participants' chances of getting lung cancer 'based on repeatedly observed associations' actually increased that risk. He did not name any policies. Other experts note that regulations and policies are not meant to require proof of causality – the Clean Air Act, for instance, says standards 'allowing an adequate margin of safety … are requisite to protect the public health'. Cox, however, has critiqued proposals to strengthen controls on pollution on the grounds of imperfectly demonstrated causality. It is the sort of logic that Cox's new AI tool could automate, which could benefit corporate interests, said Vardi of the Energy and Policy Institute. The best public interest journalism relies on first-hand accounts from people in the know. If you have something to share on this subject you can contact us confidentially using the following methods. Secure Messaging in the Guardian app The Guardian app has a tool to send tips about stories. Messages are end to end encrypted and concealed within the routine activity that every Guardian mobile app performs. This prevents an observer from knowing that you are communicating with us at all, let alone what is being said. If you don't already have the Guardian app, download it (iOS/Android) and go to the menu. Select 'Secure Messaging'. SecureDrop, instant messengers, email, telephone and post See our guide at for alternative methods and the pros and cons of each. 'Instead of having scientists-for-hire do that denial work, which advances their economic interests, the industry is funding efforts to outsource it to a machine in order to give it an image of unbiased neutrality,' Vardi said. Cox, for his part, said: 'A scientist-for-hire could use such an AI system to check whether the conclusions affirmed or denied in a scientific paper follow from the data and analyses presented, but my AI systems don't concern themselves with affirming or denying any specific positions or conclusions. That is left for people to do.' Though Cox claims his AI tool is neutral, Finkel said his early ChatGPT conversations shed light on its potential dangers. 'He was torturing the machine only along one set of preferences, which is: 'Can I force you to admit that we are being too protective?'' Finkel said. 'That's not science.' Cox said his conversations with ChatGPT aimed to uncover hidden uncertainties. But a different chatbot could be trained to identify instances in which government is 'under-regulating', Finkel said. On an academic level, Cox's interest in certainty might seem reasonable, but in the real world, it is dangerous to apply his standard of causality, said Finkel. 'For almost anything that we now know is harmful, there was a period in time when we didn't know that,' he said. If Cox's standards are taken seriously, he added, we could see 'generations, decades of misery while we wait for him to be satisfied'. This article was amended on 27 June 2025. An earlier version referred to the tobacco company 'Philip Morris'; it was has been clarified that this is a reference to Philip Morris USA, rather than Philip Morris International; the latter became a separate company in 2008.
The Guardian
5 days ago
- Health
- The Guardian
Dr Fiona Stanley: ‘If we want better health outcomes, the last thing we need is more doctors and hospitals'
Fiona Stanley arrives at South Beach Cafe at 11.30am on the dot, beaming beneath her orange sunhat. She's bright-eyed and buoyant, perhaps owing to her morning laps at Fremantle pool, a twice-weekly ritual. In the warmer months, she swims here, at South Beach, a calm, protected bay on the Indian Ocean. 'I'm an addicted ocean swimmer,' she says, as we toddle up the pathway to the beach beneath a row of Norfolk Island pines. 'But I'm so much fitter since I joined this swim group. We swam almost 2.5km this morning!' At South Beach today it's 19C, though it feels warmer. The water is glass-flat; the sky, a cloudless blue dome. Mothers with babes in arms are splashing about in the shallows, and high up in the pines, magpies sing their languid warble. 'Now, I must tell you about this,' Stanley says, as we kick off our shoes and plunge our feet into the sand. She's proudly clutching a book called First Knowledges Health: Spirit, Country and Culture, which she co-authored. Part of an eight-book series, it explores how Indigenous approaches to healthcare can solve today's problems – detailing cultural rituals such as birthing on Country and end-of-life care. 'I just love, love, loved writing this,' she says smiling. One of Australia's leading experts in epidemiology, child and maternal health, and Indigenous health, the book is a convergence of everything Stanley has spent her life fighting for. She is vivacious company – quick to laugh, warm with strangers, her mind firing off in many directions at once. As we walk, she stoops to collect a discarded bottle-top from the sand, stashing it in her pocket mid-sentence. She's nearing 80, but the same relentless energy that defined her career is still there, bubbling under the surface. Birthing on Country has become a national movement, says Stanley, holding up the book. 'It's about offering warm, family-centred care delivered by Aboriginal midwives, often in hospitals or clinics, supported by the best western diagnostics but under an Aboriginal-controlled umbrella. 'The outcomes are amazing. It's halved preterm birth rates in Aboriginal births. It's halved infant mortality. But the thing that really got me is that it reduced children being taken into out-of-home care by about 40% … What is that saying? That's saying, 'I'm a good mother. You can't take my baby away.'' Stanley is best known for founding the Telethon Institute for Child Health Research, which became internationally recognised for showing that folic acid taken before and during pregnancy can prevent spina bifida. She also helped establish the Australian Research Alliance for Children and Youth, and was instrumental in setting up Aboriginal-controlled health research units. That drive, she says, stems from both childhood idealism and hard-earned experience. Stanley grew up in Sydney in a prominent scientific household – her father, Neville Stanley, helped develop Australia's polio vaccine before the family moved to Perth in 1956. As we stroll along the shoreline, she recalls a vivid dream she had at age eight. 'We had this little boat on Sydney harbour,' she says. 'So in my dream, I'd sail to these beautiful islands, vaccinate the locals, then sail off again. I had no idea what I was doing – but I knew I wanted to help.' But the path became clearer years later, during her early days as a junior doctor at Princess Margaret hospital in Perth. 'There was an Aboriginal boy, maybe four or five, who'd come in from a remote community,' she says. 'He had severe diarrhoea and dehydration. And he died in my arms.' She pauses. 'I was 25. And I remember thinking, I don't know if I can keep doing clinical work. I need to understand how we prevent this.' Soon after, she joined a volunteer medical team travelling to remote Aboriginal communities across Western Australia. 'We went from the Eastern Goldfields to Mount Margaret, to every mission, reserve and camp … all the way up to Kalumburu,' she says. 'I saw the conditions. I saw the racism. I saw the consequences.' Stanley is the first to acknowledge that those early efforts weren't perfect. 'It was a group of white do-gooders,' she says wryly. 'Very paternalistic, especially back then.' But in those formative years, she was working alongside Aboriginal leaders such as Eric Hayward, a Noongar writer and health advocate, to challenge structural racism. She recalls one trip to Narrogin – 'one of the most racist towns in WA' – where a local doctor had refused to treat an Aboriginal child without upfront payment. 'The mother raced the kid to Katanning and it died on the way,' she says. 'So Eric and I got that doctor struck off the register.' We take a seat on a low limestone wall overlooking the beach. A mother strolls past with a baby on her hip and Stanley lights up. 'Oh my God, that baby is so cute,' she calls out. 'How old?' 'Seven months,' the woman replies. 'He's adorable. Just adorable,' Stanley says, before turning back to me. 'You know,' she says, 'the earlier we intervene in a child's life, the better. That's why I care so much about birthing on Country. Non-Aboriginal women benefit from these methods too – everyone benefits.' The conversation takes a casual turn as we talk about life since she retired in 2011, about being a grandmother, about her fondness for yoga and long walks, and the death of her husband Professor Geoffrey Shellam, who passed away in 2015. She speaks of him with tenderness – her intellectual equal, a fellow scientist and the person she bounced ideas off for decades. 'My husband became the professor of microbiology at UWA [University of Western Australia], which was my father's chair,' she says, laughing. 'After he died I moved down to Fremantle. And now I'm a Freo tragic, I love it here.' But, of course, Stanley has had a lot more on her plate than swim club and yoga. She still holds various academic and board positions, and advocates for many causes. 'I've also got more freedom now,' she says with a rebellious grin. 'I'm not running an institute any more. I'm not dependent on government money. So I can say what I like.' She's outspoken about the dangers of the North West Shelf extension, describing climate change as 'the biggest threat to human health'. Her disappointment over the failed voice to parliament referendum is equally fierce. 'We know Indigenous-led services work,' she says. 'It's not just moral – it's evidence-based.' For Stanley, these issues are all part of a bigger picture: rethinking what health really means, and who gets to shape it. The real challenge, she argues, is getting policymakers to think beyond hospitals and specialist care. 'If we want better health outcomes, the last thing we need is more doctors and more hospitals,' she says. 'We need to invest in social supports, early intervention, community-led programs.' She points to the United States as a cautionary tale. 'They spend more on health than anyone else and have the worst outcomes in the developed world,' she says. 'We need systems that keep people well, not the systems that pick them up after they're broken.' Before we know it, our hour is up and it's time for photography before Stanley whizzes off to another meeting. The photographer, Tace Stevens – a Noongar and Spinifex woman – introduces herself, and Stanley's face softens. 'Where's your mob from?' she asks instinctively. 'My father is from Cundeelee mission,' Stevens replies. Stanley's eyes well with tears. 'That was one of the first places I ever visited,' she says quietly. 'It changed me.' After the photoshoot, she gives both of our hands a squeeze before striding back to her car. On to the next thing. First Knowledges Health: Spirit, Country and Culture, co-authored by Fiona Stanley, Shawana Andrews and Sandra Eades, is out now (A$24.99, Thames & Hudson).
The Guardian
5 days ago
- Business
- The Guardian
Inside a plan to use AI to amplify doubts about the dangers of pollutants
An industry-backed researcher who has forged a career sowing doubt about the dangers of pollutants is attempting to use artificial intelligence (AI) to amplify his perspective. Louis Anthony 'Tony' Cox Jr, a Denver-based risk analyst and former Trump adviser who once reportedly claimed there is no proof that cleaning air saves lives, is developing an AI application to scan academic research for what he sees as the false conflation of correlation with causation. Cox has described the project as an attempt to weed 'propaganda' out of epidemiological research and perform 'critical thinking at scale' in emails to industry researchers, which were obtained via Freedom of Information Act requests by the Energy and Policy Institute, a non-profit advocacy group, and exclusively reviewed by the Guardian. He has long leveled accusations of flimsiness at research linking exposure to chemical compounds with health dangers, including on behalf of polluting interests such as cigarette manufacturer Philip Morris and the American Petroleum Institute – a fossil fuel lobbying group he has even allowed to 'copy edit' his findings. (Cox says the edit 'amounted to suggesting a small change' and noted that he has also obtained public research funding.) Both the tobacco and oil industries have a history of weaponizing scientific uncertainty, experts say, with some arguing that similar tactics drive the Trump administration's current deregulatory efforts. The president's May 'gold standard' science order, for instance, empowered his appointees to 'correct scientific information' and 'discipline' those who breach the administration's views, prompting outrage from some scientists. Cox has obtained funding to develop the new AI reviewer from the American Chemistry Council (ACC), the nation's largest chemical industry advocacy group, which counts oil and chemical giants such as Exxon and DuPont as members. Experts say the ACC's sponsorship raises questions about whom the project will benefit. Asked about these concerns, Kelly Montes de Oca, spokesperson for the ACC, said: 'This research has the potential to support scientific understanding and analysis of chemical exposure and human health, enhance transparency and reproducibility, advance the safety of chemical products and processes, and inform science-based global regulatory approaches.' Cox said in an email to the Guardian that his assistant 'is specifically designed to be helpful to those who wish to understand the objective implications of data without any distortions from the kinds of well-known human heuristics and biases that make objective analysis difficult for humans'. 'My work aims to help anyone interested in using sound technical methods to pursue scientific truth,' he added. The questions sent to him by the Guardian contained 'many fundamental inaccuracies', he said. Cox said the tool is currently being tested on submissions to academic journals – including Risk Analysis, which he edits – to evaluate research submissions before they are submitted to the peer review process. Asked for a response to concerns about the project's funding, Cox said that he has publicly acknowledged the ACC's support in all relevant publications and said the tool 'has no axe to grind and no positions to push'. But the ACC is not a neutral force, said Chris Frey, the associate dean for research and infrastructure at the North Carolina State University's College of Engineering who chaired the Environmental Protection Agency's clean air scientific advisory committee from 2012 to 2015. 'They lack impartiality in that they want to minimize regulatory burden on their members,' said Frey. In mid-February of 2023, Cox struck up a conversation with the AI assistant ChatGPT. He later sent the chat to his University of Colorado email address, which is subject to public record request laws. After asking the chatbot to write a sonnet about Abraham Lincoln, he turned the conversation to a more serious topic: the tiny toxic particles known as PM2.5, also known as fine particulate matter. Scientists have long found links between PM2.5 exposure and a wide variety of health concerns, from asthma and lung disease to heart attacks. But for years, Cox has raised uncertainty about those connections, publishing work 're-assessing' the mortality risks associated with exposure to the pollutant in animal agriculture and challenging the link between PM2.5 from gas stoves and childhood asthma. On that February day, Cox asked ChatGPT a simple question: 'Does PM2.5 cause lung cancer?' The bot responded by noting the 'strong scientific evidence' demonstrating the link. A seemingly dissatisfied Cox went on to ask if it is 'known with certainty that PM2.5 causes lung cancer', calling on ChatGPT to identify potential confounding factors in the research on the air pollutant. He took brief tangents to pose riddles to the bot and to request additional sonnets – including one about PM2.5 itself, yielding the line 'no nose can catch you, for you are so fine'. Eventually, Cox asked ChatGPT whether the association between PM2.5 and lung cancer can be explained by a 'combination of residual confounding, measurement errors, and modeling biases'. The bot maintained that 'the observed association is likely to be real and not fully explained by these factors'. From a conversation Cox had with ChatGPT in February 2023 Write a sonnet about PM2.5 and lung cancer Oh, deadly PM2.5 in the air, So small and yet so full of poison's might, A silent killer that we cannot bear, You infiltrate our lungs both day and night At the time of the conversation, Cox had already been interested for years in making 'smarter and more trustworthy AI', he told the Guardian. He had published a paper on the topic in 2021, and the following year – months before ChatGPT's release – had begun developing his own AI tool. The ACC had partly funded that work, he said. Cox also had a meeting with the Long-Range Research Initiative, a lobbying group focused on 'innovations in chemical safety science' which includes Exxon, just hours before he had the February 2023 ChatGPT conversation, the emails show. In an email seeking funding to develop an AI tool, Cox seemingly referenced that 'long experimental chat'. Among the recipients were George Maldonado, the editor of the academic journal Global Epidemiology, and ACC toxicologist Rick Becker. Cox wrote in the email that his questions eventually led ChatGPT to 'concede that we don't actually know that PM2.5 at current ambient levels causes lung cancer in humans – but it was a struggle to get there!' The chatbot 'does an excellent job of reflecting the 'party line' that is most prevalent on the web, fallacies and all', Cox continued in the email. But new AI software could be used to do ''critical thinking at scale' (if I may be grandiose!)', he said. The following day, Cox emailed a larger group of researchers, including Becker and two ExxonMobil scientists. ChatGPT, he wrote, 'seems to me to display a very strong starting bias that can eventually be overcome by sufficiently patient questioning'. That bias involved conflating 'evidence of association with evidence of causation', he said. From an email Cox sent to industry researchers in February 2023 We can help bend applications of this technology toward scaled-up critical thinking instead of scaled-up groupthink and propaganda 'I am hoping to build a critical mass of interest and get some funding in this area so that we can help bend applications of this technology toward scaled-up critical thinking instead of scaled-up groupthink and propaganda,' he added. Cox's past work may shed light on the 'groupthink and propaganda' that his work questions. In one 2023 study he co-authored, he found that exposure to the 'forever chemical' known as PFOA can occur in safe doses. The research was conducted with the organization Toxicology Excellence for Risk Assessment, headed by the contentious toxicologist Michael Dourson, who has also received funding from chemical makers. Another study the same year, which Cox co-authored with a Chevron toxicologist, said molybdenum – a petrochemical present in lubricants Chevron produces – was 'not a risk factor for changes in serum testosterone'. And in a third 2023 study, Cox said his research found no link between childhood asthma and gas stove exposure. At a 2018 conference, Cox also claimed there is no proven connection between air pollution and respiratory problems or heart attacks, while he said in a 2012 paper – funded in part by tobacco company Philip Morris – that he found smoking half a pack of cigarettes daily did 'not appear to be associated' with increased risk of coronary heart disease. In an email to the Guardian, Cox said the methods he applies are 'drawn from the scientific mainstream – not from ideology or partisanship'. 'Some critics have mischaracterized my work as an attempt to delay regulation or promote industry interests. That is not true,' he said. 'I do not advocate for or against any policy outcome. I advocate for grounding decisions in empirically supported causal understanding.' Cox served as an adviser to policymakers in his role on an EPA advisory committee. He has also argued against the proposed tightening of a regulation at an Occupational Safety and Health Administration hearing, in his capacity as an ACC consultant. Adam Finkel, a risk analyst and environmental health sciences professor at the University of Michigan, said though he believes Cox to be in some ways a 'genius' and skilled risk analyst, he also seems to be 'deceiving himself and everyone else' about the impacts of bias on his research. 'How you interpret any information is by imposing your preferences,' said Finkel, who is also a former director of health standards programs at the US Department of Labor's Occupational Safety and Health Administration. 'There is no possible way to get around imposing some set of preferences.' Some degree of uncertainty is inherent to scientific analysis. But when assessing whether or not there is a causal effect between exposure to something potentially harmful, Finkel said, Cox looks for 'perfect certainty', which 'can lead to years and decades of doing nothing and harming people while you wait for the certainty to come'. While Finkel has 'fundamental belief that our system is under-protective' when it comes to public health, Cox seems to believe the opposite. Asked for comment, Cox said: 'I have never advocated that we should not act until we have certainty. Rather, I have advocated choosing to act on the best available information.' He said his work has acknowledged causal relationships between smoking and lung cancer, asbestos exposure and mesothelioma, and, in 2011, crystalline silica exposure and lung disease. But at the Occupational Safety and Health Administration hearing at which he spoke in 2014, Cox asserted on behalf of the ACC that the federal government had not demonstrated a link between certain levels of silica exposure and lung disease. 'He'll accept that at very high doses, this stuff is bad for you,' said Finkel. Policy is meant to ensure that level of exposure doesn't occur, he added. Maldonado, editor of Global Epidemiology, responded positively to Cox's AI assistant proposal, the emails from 2023 show. Within weeks, his journal published another one of Cox's conversations with ChatGPT in his journal. 'The purpose of this comment is to provide an example of a Socratic dialogue with ChatGPT about the causal interpretation of an important epidemiological association between exposure to fine particulate matter air pollution (PM2.5) and mortality risk,' says the paper, which states that it was partly funded by the ACC and counted climate denier Steve Milloy as one of its reviewers. When the bot said 'it is well-established that exposure to ambient levels of PM2.5 does increase mortality risk', Cox accused it of confusing evidence of association with evidence of causation. Eventually, ChatGPT said: 'It is not known with certainty that current ambient levels of PM2.5 increase mortality risk.' But the distinction between correlation and causation is 'epidemiology 101', said Gretchen Goldman, president of the scientific advocacy group Union of Concerned Scientists, who co-authored a 2019 paper critiquing Cox. 'From day one of a study, researchers consider, analyze and guard against possible confounding factors,' said Goldman. 'This uncertainty is always present, but that of course doesn't mean the research is wrong.' Demonstrating clear causal links between pollutants and health impacts can be complicated, especially because unlike in testing pharmaceuticals, it can be difficult and unethical to establish control groups for comparison. 'If you're looking at the effects on an actual population that's been exposed in real life to pollutants, you can't do those controlled types of studies,' said Frey of North Carolina State University's College of Engineering. 'That leads to thinking about ways to make inferences from real world data that might, for example, mimic a random, controlled trial.' But though demonstrating true causality can be complex, Cox has long overstated scientific uncertainty while downplaying evidence, said Frey. 'Science denialism often sounds convincing because it contains some truthiness to it or elements of truth or elements of valid points, but it's often based on either overemphasis or omission and doesn't portray a full picture,' he said. As chair of EPA's clean air scientific advisory committee during Trump's first presidential term, for instance, Cox proposed eliminating all research from the agency's consideration that did not demonstrate 'manipulative causation', wherein intervention on one variable would change the probability of an outcome. 'I see it as being about using widely accepted, non-controversial principles of causal analysis and inference,' Cox said of his push for this change. But in effect, the alteration would have dramatically and unnecessarily 'winnowed down' the body of evidence to which the EPA could have referred and removed research from consideration which 'in fact robustly' demonstrates that certain compounds cause harm, Frey said. 'That effort and his work generally have not been viewed as compelling by the mainstream scientific community,' he added. Industry interests have promoted uncertainty to defend their business models, Frey said. The oil sector, for instance, had strong evidence that fossil fuels warmed the planet as early as the 1950s yet publicly called the link 'weak' or even 'non-existent' for decades. Cigarette manufacturers also long promoted the idea that the connection between cigarettes and health harms was tenuous, with one tobacco executive even saying in 1969 that 'doubt is our product'. 'It's a well-worn tactic,' said Frey. Cox kept corresponding with industry scientists about his new tool, all the while holding similar conversations with ChatGPT about causation in research. In May 2023, for instance, Cox posed questions about the causal claims in a recent landmark study linking gas stove exposure to childhood asthma, the emails show. Later that month, Cox sent a slideshow to the ACC's Becker and several other industry-related scientists. His reviewer, it showed, had identified issues with the recent gas stoves study, and another major assessment which linked PM2.5 exposure to cardiovascular issues. This tool could 'benefit authors, reviewers, reporters, media (if we make the summary reports good enough), and decision-makers and policymakers trying to evaluate studies and decide how trustworthy their methods and conclusions are', Cox said. In a proposal sent days later, he added that it is 'probably good enough to be commercially useful'. In July 2023, Cox presented his new tool to members of the Long-Range Research Initiative – which also funded his earlier work – including to representatives from Exxon. Ahead of the meeting, Cox sent the group a conversation he had with the reviewer, which used a 2020 paper demonstrating a causal link between PM2.5 and mortality as an example of the kind of conflation his tool could spot. Maldonado, the editor of Global Epidemiology, offered to give the tool a 'friendly trial' at his journal. From an email Cox sent to the American Chemistry Council's Becker in July 2023 Such automated critical reasoning can help to thoroughly review, and potentially to improve, the scientific claims and scientific integrity of causal reasoning and presentation of evidence underlying many regulatory risk assessments After the meeting, Cox sent a two-part project proposal to the ACC. 'Such automated critical reasoning can help to thoroughly review, and potentially to improve, the scientific claims and scientific integrity of causal reasoning and presentation of evidence underlying many regulatory risk assessments,' Cox said. For part one, an academic paper on the project which would be published in Maldonado's Global Epidemiology, he asked for $75,000. For part two, a pilot testing the reviewer on submissions to the same journal, he asked for $80,000. In his response to questions from the Guardian, Cox confirmed the ACC's funding but not a dollar amount. Cox published the 'phase 1' paper about his new AI reviewer in the journal Global Epidemiology in June 2024. He also appears to have secured $40,000 for Global Epidemiology to participate in the second phase, but the partnership 'did not come to fruition' because too few authors were willing to participate, Cox told the Guardian. Maldonado did not respond to a request for comment. By April 2024, Cox told the ACC's Becker in an email that his reviewer tool was 'ready for a demo', claiming its reviews are 'already better than many human reviews, although not as on-point and insightful as the best human reviews'. But in an email last May to toxicologist Ted Simon, Cox said 'the real goal' of the tool was to enable it to do literature reviews, examining wide swaths of published information in a particular subject area. That month, ExxonMobil scientist Hua Qian ran a test of the tool. Now, Cox told the Guardian, the tool was being tested by researchers submitting work to the journal he edits, Risk Analysis, and other academic journals, including Decision Analysis. About 400 people have tested the tool so far. Itai Vardi, a manager at the Energy and Policy Institute, who shared the trove of emails with the Guardian, said the project could have disastrous consequences for academia, particularly epidemiology. 'AI language models are not programmed, but built and trained,' he said, 'and when in the hands and funding of this industry, can be dangerous as they will further erode public trust and understanding of this crucial science.' Asked about critics' concerns about the ACC's funding for the project, Cox said: 'People who are concerned about the use of sound science in areas where politics has dominated might understandably be concerned about the use of such tools.' But people should 'favor the development' of the AI tool if they want to 'apply sound science to improve our understanding of the world and how to act more effectively', he said. 'The fact that the ACC … are starting to step up to the challenge of designing AI to increase the objectivity, transparency, and trustworthiness of scientific research seems to me to be a great public benefit,' he said. But the ACC 'cannot be trusted as a source of 'objectivity, transparency, and trustworthiness of scientific research',' said Frey, when that research is 'aimed at understanding the human health harms caused by chemicals manufactured by their members'. And for him, Cox's use of the term 'sound science' also prompted concern. ''Sound science' is a term popularized by the tobacco industry as part of a campaign to create burdens of proof far beyond those required for policy decisions,' Frey said. Indeed, in the 1990s, Philip Morris – for whom Cox has done research – ran a 10-year 'sound science' public relations campaign to sow doubt about the harm cigarettes cause. In an email to the Guardian, Cox noted that 'reputable scientists' use the term to refer to reliable, verifiable research that follows accepted scientific methods. He dismissed the idea that causation can be difficult to prove in epidemiology. 'My response to people who are concerned that we should treat evidence of repeated associations as if it were evidence of interventional causality is that this outdated style of thinking is tremendously harmful and counterproductive in designing effective measures to successfully protect human health and safety,' he said. Asked for examples of harmful policies created by overreliance on association, Cox named several scientific studies, including a 1996 experiment which was stopped because interventions that were expected to slash participants' chances of getting lung cancer 'based on repeatedly observed associations' actually increased that risk. He did not name any policies. Other experts note that regulations and policies are not meant to require proof of causality – the Clean Air Act, for instance, says standards 'allowing an adequate margin of safety … are requisite to protect the public health'. Cox, however, has critiqued proposals to strengthen controls on pollution on the grounds of imperfectly demonstrated causality. It is the sort of logic that Cox's new AI tool could automate, which could benefit corporate interests, said Vardi of the Energy and Policy Institute. 'Instead of having scientists-for-hire do that denial work, which advances their economic interests, the industry is funding efforts to outsource it to a machine in order to give it an image of unbiased neutrality,' Vardi said. Cox, for his part, said: 'A scientist-for-hire could use such an AI system to check whether the conclusions affirmed or denied in a scientific paper follow from the data and analyses presented, but my AI systems don't concern themselves with affirming or denying any specific positions or conclusions. That is left for people to do.' Though Cox claims his AI tool is neutral, Finkel said his early ChatGPT conversations shed light on its potential dangers. 'He was torturing the machine only along one set of preferences, which is: 'Can I force you to admit that we are being too protective?'' Finkel said. 'That's not science.' Cox said his conversations with ChatGPT aimed to uncover hidden uncertainties. But a different chatbot could be trained to identify instances in which government is 'under-regulating', Finkel said. On an academic level, Cox's interest in certainty might seem reasonable, but in the real world, it is dangerous to apply his standard of causality, said Finkel. 'For almost anything that we now know is harmful, there was a period in time when we didn't know that,' he said. If Cox's standards are taken seriously, he added, we could see 'generations, decades of misery while we wait for him to be satisfied'.
Medscape
7 days ago
- Health
- Medscape
Higher Stroke Risk Decades After Adverse Pregnancy Outcomes
A significant risk for stroke was found up to 46 years after delivery in a third of women who'd had any of five adverse pregnancy outcomes, according to a large national cohort study. An international team of investigators discovered that compared with women who'd had no adverse pregnancy outcomes, those who'd experienced preterm delivery, delivery of an infant small for gestational age, preeclampsia, other hypertensive disorders, or gestational diabetes, still faced a 1.2- to 2.5-fold greater risk for stroke anywhere from 30 to 46 years after delivery. The results were published in the European Heart Journal . 'Women with adverse pregnancy outcomes need early preventive actions and long-term follow-up to reduce their lifelong risk of stroke,' wrote the investigators led by Casey Crump, MD, PhD, MS, MPH, an epidemiologist in the Departments of Family and Community Medicine and Epidemiology, The University of Texas Health Science Center, Houston. About a third of all women in their reproductive years experience an adverse pregnancy outcome, according to experts. Meanwhile, stroke is the third leading cause of death worldwide, with women bearing the brunt of the disease. To determine which adverse pregnancy outcomes are associated with the highest risk for stroke in women, Crump and his co-investigators examined data on 2,201,393 women who gave birth to a singleton between 1973 and 2015 in Sweden. The cohort was followed up for stroke through 2018. Cox regression was used to determine hazard ratios (HRs) for stroke associated with each of the five adverse outcomes and was adjusted for other maternal factors such as age, BMI, and smoking history. Crump and colleagues found that in 48 million person-years of follow-up, 667,774 (30%) women experienced an adverse pregnancy outcome and 35,824 (1.6%) women were diagnosed with any form of stroke, including ischemic or hemorrhagic stroke with all its major subtypes such as intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage. All five adverse pregnancy outcomes were independently associated with long-term increased risks of stroke. With up to 46 years of follow-up, the highest adjusted HR for stroke was associated with gestational diabetes at 1.86 (95% CI, 1.69-2.04). For hypertensive disorders other than preeclampsia, the HR was 1.82 (95% CI, 1.67-1.98). For preterm delivery it was 1.40 (95% CI, 1.36-1.45) and for preeclampsia, the HR was 1.36 (95% CI, 1.31-1.41). In deliveries with the infant being small for gestational age, the HR was 1.26 (95% CI, 1.22-1.29). All HRs remained significantly elevated (1.2- to 2.5-fold) even 30-46 years after delivery. The adjusted HRs for associated stroke were highest in the first 10 years after delivery in hypertensive disorders other than preeclampsia, preterm delivery, and small for gestational age. However, the adjusted HRs associated with gestational diabetes, largely mediated by type 2 diabetes, increased with additional follow-up time between 30 and 46 years (2.51; 95% CI 2.15-2.93). Genetics and common familial factors only partially explained the stroke risks. The investigators conducted co-sibling analyses for potential confounding by shared genetic or environmental factors such as air pollution or passive smoking in 1,191,316 (54%) women in the cohort who had at least one full sister who also had a singleton delivery, regardless of adverse outcome status. Psychological factors could also be at play in the sustained elevated stroke risk, according to Abbi D. Lane, PhD, an assistant professor of applied exercise science at the University of Michigan School of Kinesiology, Ann Arbor, Michigan, who wrote an editorial accompanying the study. 'Not only does the complicated pregnancy/birth itself cause stress, but the psychological and/or medical sequelae of the adverse pregnancy outcome can last for months or years,' Lane wrote. Referencing the 2017 INTERSTROKE Study of population level risks for stroke, Lane noted that the population-attributable risk associated in women with psychosocial stress (15.0%; 95% CI 8.5%-25.2%), which was measured using questions about work and home stress, life events, and depression, was similar to that associated with poor diet (22.9%; 95% CI 15.3%-32.7%), cardiac causes (11.1%; 95% CI 9.4%-12.9%), and smoking (5.3%; 95% CI% 3.7%-7.6%). 'Babies born after an adverse pregnancy outcome are more likely to be admitted to the neonatal intensive care unit,' she wrote. '[They] are more likely to have short- or longer- term medical complications and to be diagnosed with neurodevelopmental disorders. Managing medical and neurodevelopmental disorders can lead to months or years of emotional, logistical, and financial strain for parents.' The INTERSTROKE study's finding that strokes are 90% preventable, plus this study's finding that a third of women with adverse pregnancy outcomes have an elevated risk for stroke, requires preemptive action, according to Lane. 'Delivery methods for any postpartum intervention could include home-based or virtual sessions to reduce child care or travel burden, and improve feasibility,' she wrote. Another expert said the study also provides opportunities for treating patients at risk for stroke. 'This study adds to our clinical practice by emphasizing the need to acknowledge sex-specific risk factors and their impact on stroke risk while actively improving their current modifiable risk factors with individualized care,' Lily Dastmalchi, DO, told Medscape Medical News . Dastmalchi is a cardiologist at the Inova Health System in greater Washington, DC.
