Quantifying Potential Health Impacts of Cadmium in Cigarettes on Smoker Risk of Lung Cancer: A Portfolio-of-Mechanisms Approach

This article introduces an approach to estimating the uncertain potential effects on lung cancer risk of removing a particular constituent, cadmium (Cd), from cigarette smoke, given the useful but incomplete scientific information available about its modes of action. The approach considers normal cell proliferation; DNA repair inhibition in normal cells affected by initiating events; proliferation, promotion, and progression of initiated cells; and death or sparing of initiated and malignant cells as they are further transformed to become fully tumorigenic. Rather than estimating unmeasured model parameters by curve fitting to epidemiological or animal experimental tumor data, we attempt rough estimates of parameters based on their biological interpretations and comparison to corresponding genetic polymorphism data. The resulting parameter estimates are admittedly uncertain and approximate, but they suggest a portfolio approach to estimating impacts of removing Cd that gives usefully robust conclusions. This approach views Cd as creating a portfolio of uncertain health impacts that can be expressed as biologically independent relative risk factors having clear mechanistic interpretations. Because Cd can act through many distinct biological mechanisms, it appears likely (subjective probability greater than 40%) that removing Cd from cigarette smoke would reduce smoker risks of lung cancer by at least 10%, although it is possible (consistent with what is known) that the true effect could be much larger or smaller. Conservative estimates and assumptions made in this calculation suggest that the true impact could be greater for some smokers. This conclusion appears to be robust to many scientific uncertainties about Cd and smoking effects.     

ASSESSING THE RELATIONSHIP BETWEEN SYMPTOMS OF ALLERGIC RHINOCONJUNCTIVITIS AND POLLEN COUNTS

The relationship between daily pollen counts during the peak pollen season and hay fever symptoms in known sufferers of pollen allergy was investigated in a Sydney hospital‐based study. This paper develops statistical models for both the short term (day to day) associations and the longer term relationships between these time series. Possible effects of asthma status are investigated. The analyses illustrate how different relationships between time series may be explored in a simple way by working on different time scales with suitably transformed variables.     

Sensitivity to bodily nonverbal communication as a factor in practitioner-patient rapport

The relationship between physicians' nonverbal sensitivity and the satisfaction of their patients was tested in two field studies. In the first study, 40 physicians were given a film test of nonverbal sensitivity (the PONS test) and were evaluated by their patients. The second study was a replication using 31 additional physicians. Most noteworthy for research in therapeutic interaction, the present studies contained three methodological advances: (1) the use of actual patients' ratings of satisfaction with treatment, (2) the extension of research from psychological to medical settings, and (3) the use of a standardized test of nonverbal decoding skill. Physicians' skill at reading the emotion conveyed through the nonverbal channel of body movement was found to be significantly correlated with their interpersonal success with patients in the clinical setting.The authors would like to thank Donald Dickson, M.D., Mary Ann Spadaro, M.D., Louise M. Prince, John L. Helmuth, Jr., Helene M. Murphy, and the physicians and patients who participated in the research. Study I was supported by a Peter B. Livingston Fellowship from the Massachusetts Mental Health Center and Study II by a W. K. Kellogg Fellowship from the Hospital Research and Educational Trust, both to the senior author.     

COMPETITIVE INDUSTRY EQUILIBRIUM UNDER UNCERTAINTY AND FREE ENTRY

This paper investigates the properties of industry equilibrium under price uncertainty given free entry and exit. For any form of risk-averse behavior, it is shown that an increase in demand uncertainty (as measured by a mean-preserving spread) increases mean output price and reduces output of firms in long-run equilibrium.