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Bias, Conflict of Interest, Ignorance, and Uncertainty
Published in Ted W. Simon, Environmental Risk Assessment, 2019
Evidence-based medicine is based on assessing the totality of evidence regarding a particular medical intervention. Evidence-based toxicology attempts to apply similar approaches to the assessment of the totality of evidence regarding the toxicity of substances. This evidence includes studies in animals, humans, cells, or tissues in vitro, computational toxicology, and predictive methods such as QSAR. The practices of systematic reviews of evidence, transparency in decisions, open data disclosure, synthesis of different types of evidence, and assessment of bias/credibility are just beginning to be applied in toxicology.68,96,155–161
Hexavalent chromium and stomach cancer: a systematic review and meta-analysis
Published in Critical Reviews in Toxicology, 2019
Mina Suh, Daniele Wikoff, Loren Lipworth, Michael Goodman, Seneca Fitch, Liz Mittal, Caroline Ring, Deborah Proctor
One limitation of this systematic review is that most occupational studies had a probably high or definitely high risk of bias for confounding and exposure. Statistical adjustment for confounding variables was presented in only three studies (Xu et al. 1996; Krstev et al. 2005; Ahn et al. 2006). Exposure characterization methods in most studies were of poor quality, and as discussed above, only a handful of studies conducted exposure assessment based on quantitative data and methods (Xu et al. 1996; Lipworth et al. 2011; Gibb et al. 2015; Proctor et al. 2016). As a consequence, the level of confidence in the evidence from human studies was low to moderate. Additionally, data for non-occupationally exposed populations were sparse and low quality due to reliance on ecologic study design. For this reason, non-occupational studies could not be included in the systematic review and meta-analysis. It is also important to acknowledge that any systematic review involves an element of judgment. More quantitative bias-adjusted approaches could be employed in the future (Doi et al. 2013). Additional research and discussion are ongoing in the field of evidence-based toxicology, because practitioners recognize that existing tools could be refined to better categorize and integrate data in the context of chemical risk assessment (EFSA 2017).