Table 8.

Summary of Recommendations

Recommendations for Epidemiology
Epidemiologic investigations should strive to employ markers of exposure and upstream effect to enhance study sensitivity
Develop a consistent format for epidemiologic results reporting to facilitate cross-study comparisons and data combination methods
Susceptibility factors should be analyzed as effect modifiers
Conduct joint analyses when data on multiple related exposures or outcomes are available
Recommendations for Risk Assessment
Use the dose-response information from epidemiologic studies of noncancer effects as the basis for developing quantitative risk estimates
Risk assessments should move toward a more systematic and transparent evaluation of the existing evidence
EPA should develop a set of data sufficiency and evaluation criteria for epidemiologic data to be applied uniformly across different types of endpoints
EPA’s definition of “critical effect” used in developing toxicity values for risk assessment should be consistent with its definition of “adverse effect” and include early upstream events
Risk assessors should reframe the concept of critical effect to move beyond determination of a single adverse endpoint to consider syndromes and groups of adverse endpoints that stem from the same initial biological perturbation
Trans-Disciplinary Recommendation
Create opportunities for cross-disciplinary training and collaboration between epidemiologists and toxicologists. Epidemiologists should be provided with training in regulatory risk assessment