Is bad air quality slowly harming us? (with Richard Bruns)
Oct 11, 2023
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Richard Bruns, an environmental expert, discusses the impact of air quality on health, including the dangers of PM2.5 particles and the importance of effective air filters. They also explore the effects of bad air quality on cognitive performance and the process of drug approval. Additionally, they touch on topics like side-effect labeling for medications and the relationship between kindness and morality.
Poor air quality, particularly PM2.5 particles, can have significant health impacts, including respiratory problems and cardiovascular diseases.
The FDA's cautious approach in approving drugs is driven by the fear of approving unsafe medications, but suggestions for modifying the approval process include more rigorous cost-benefit analysis and conditional approvals.
The impact of saturated fats on health is still debated, while trans fats are widely recognized as harmful; individuals may be affected differently by saturated fats.
Deep dives
Air Quality and Health Impacts
The podcast episode discusses the importance of air quality and its impact on health. Poor air quality can have both acute and chronic effects on the lungs and heart, leading to respiratory problems, cardiovascular diseases, and even death. The evidence for these health effects mostly comes from epidemiological studies, including natural experiments and outdoor air sensors. Fine particulate matter, known as PM2.5, which includes small particles found in air pollution, is particularly harmful and can enter the lungs and bloodstream, causing damage. While the size and composition of particles may vary, PM2.5 is generally considered dangerous regardless. Improving air quality by using better air filters and reducing exposure to pollution can significantly benefit overall health and reduce the risk of related diseases.
The Role of the FDA
The podcast episode touches on the role of the FDA in approving drugs and the challenges it faces in balancing safety and efficacy. The FDA is often criticized for being too slow in approving potentially life-saving medications, leading to missed opportunities and preventable deaths. However, the FDA's cautious approach is partially driven by the fear of approving drugs that may later be found to be unsafe. There are suggestions to modify the approval process, such as implementing more rigorous cost-benefit analysis and creating different levels of approval based on the strength of evidence. Unbundling the process and allowing conditional approvals can provide earlier access to promising treatments while still ensuring safety standards are met.
Understanding Saturated Fats and Trans Fats
The podcast episode briefly touches on fats and their impact on health. Saturated fats have been demonized in the past, but recent suggestions question whether they are as harmful as previously believed. The debate around fats often centers on their impact on cardiovascular health and related diseases. While trans fats, specifically artificial trans fats, have been shown to be highly detrimental to health and are now banned in many places, the effects of saturated fats can vary depending on individual factors. Some individuals may benefit from reducing saturated fats in their diets, while others might not experience the same negative effects.
Improving FDA Decision-Making
The podcast episode highlights the need for the FDA to incorporate more quantitative analysis, particularly cost-benefit analysis, into its decision-making processes. The current regulatory system relies heavily on subjective judgments and word-based classifications, leading to potential inconsistencies and delays. By adopting a more data-driven approach, the FDA can make more transparent decisions that consider the trade-offs between risks and benefits. This could involve utilizing disability-adjusted life years (DALYs) to assess the overall impact of diseases and treatments, and applying Monte Carlo simulations to estimate probabilities and severity of side effects. Implementing these changes could help optimize timeliness and effectiveness in the FDA's approval processes.
Replication Crisis in Psychology Research
The podcast discusses the replication crisis in psychology research, where many past experimental results have failed to be replicated. This calls into question our understanding of human behavior and the reliability of previous findings. To address this crisis, the team at Clearr Thinking has launched Transparent Replications, a project that conducts rapid replications of published psychology studies using open science practices. The results of these replications are freely available on their website, aiming to improve reliability and promote clarity in psychological research.
The Challenges of Side-Effect Labeling and Bureaucracies
The podcast explores the challenges of side-effect labeling for medication and the nature of bureaucracies. Side-effect lists often lack information about the frequency and severity of each side effect, making them less useful for patients. Bureaucracies, like the FDA, are seen as machines designed for repetitive actions and procedural fairness. While they provide predictability and fairness, they can struggle with novelty and change. Individuals within bureaucracies should be aware of the rules and their purpose, while also maintaining their capacity for individual initiative. The discussion highlights the delicate balance between following rules and utilizing them as optimization constraints, particularly in entrepreneurial contexts.
How bad is the air quality in the US and around the world? What's the evidence that certain kinds of particles in the air lead to negative health outcomes? Are there differences in air quality among urban, suburban, and rural areas? And if so, then to what extent are negative health outcomes attributable to air quality rather than to (e.g.) poverty, education, or other confounding factors? What are "PM 2.5" particles? Can some particles be too small to matter? Are all particles of a certain size harmful, or only specific types of particles? Do damaging particles accumulate in the body over time? What can the average person do to reduce their exposure to unhealthy air? Opening windows in our homes can let in fresh air, but it can also let in harmful particles; so is opening windows a good idea or not? How relatively bad are trans fats and saturated fats? Does the FDA regulate drugs too much or not enough? Why do side effect labels usually list all possible side effects without any indication of how common those side effects are? What should a bureacracy be and not be? How can bureacracies train employees to follow rules and produce consistent outcomes without stifling individual initiative and creativity?
Richard Bruns is an economist who specializes in cost-benefit analysis of novel public health policy. He is currently a Senior Scholar at the Johns Hopkins Center for Health Security, which is an Open-Philanthropy-funded think tank devoted to protecting the world from catastrophic biological risks. For the past few years, much of his work has been focused on how indoor air quality improvements can protect us from disease. Before that, he was an economist in the food part of the Food and Drug Administration. Feel free to email him at bruns@jhu.edu about any topic in this episode, or learn more about him at his website.
