Abstract

Safety sciences must cope with uncertainty of models and results as well as information gaps. Acknowledging this uncertainty necessitates embracing probabilities and accepting the remaining risk. Every toxicological tool delivers only probable results. Traditionally, this is taken into account by using uncertainty / assessment factors and worst-case / precautionary approaches and thresholds. Probabilistic methods and Bayesian approaches seek to characterize these uncertainties and promise to support better risk assessment and, thereby, improve risk management decisions. Actual assessments of uncertainty can be more realistic than worst-case scenarios and may allow less conservative safety margins. Most importantly, as soon as we agree on uncertainty, this defines room for improvement and allows a transition from traditional to new approach methods as an engineering exercise. The objective nature of these mathematical tools allows to assign each methodology its fair place in evidence integration, whether in the context of risk assessment, systematic reviews, or in the definition of an integrated testing strategy (ITS) / defined approach (DA) / integrated approach to testing and assessment (IATA). This article gives an overview of methods for probabilistic risk assessment and their application for exposure assessment, physiologically-based kinetic modelling, probability of hazard assessment (based on quantitative and read-across based structure-activity relationships, and mechanistic alerts from in vitro studies), individual susceptibility assessment, and evidence integration. Additional aspects are opportunities for uncertainty analysis of adverse outcome pathways and their relation to thresholds of toxicological concern. In conclusion, probabilistic risk assessment will be key for constructing a new toxicology paradigm – probably!

Highlights

  • Nothing is as certain as death and taxes1

  • The other way around, “big data” is bringing the reverse challenge of overpowered studies, i.e., “massive data sets expand the number of analyses that can be performed, and the multiplicity of possible analyses combines with lenient P value thresholds like 0.05 to generate vast potential for false positives” (Ioannidis, 2019)

  • Another drawback is that frequentists neglect that opinion plays a major role in both preclinical and clinical research; Bayesian statistics forces the contribution of opinion out into the open where it belongs

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Summary

Introduction

Nothing is as certain as death and taxes. Toxicology (as all of medicine) does not reach this level of certainty, as the Johns Hopkins scholar William Osler (1849-1919) rightly stated, “Medicine is a science of uncertainty and an art of probability”, and in this sense toxicology is a very medical discipline. Aside the poor use of statistics in toxicology in general (Hartung, 2013), it will surprise many readers that our gold-standard significance test approach, which is increasingly used (Cristea and Ioannidis, 2018), is ill-suited for the questions we ask (Goodman, 1999ab)2: “Biological understanding and previous research play little formal role in the interpretation of quantitative results This phenomenon is manifest in the discussion sections of research articles and can affect the reliability of conclusions. The other way around, “big data” is bringing the reverse challenge of overpowered studies, i.e., “massive data sets expand the number of analyses that can be performed, and the multiplicity of possible analyses combines with lenient P value thresholds like 0.05 to generate vast potential for false positives” (Ioannidis, 2019) Another drawback is that frequentists neglect that opinion plays a major role in both preclinical and clinical research; Bayesian statistics forces the contribution of opinion out into the open where it belongs. The consequences (hazards) are typically quite clear, but we struggle with the probabilities. Taleb (2007) phrased it outside of toxicology, “We generally take risks not out of bravado but out of ignorance and blindness to probability!”

The lack of certainty in toxicology
Software for ProbRA
Probability of exposure
Probability of hazard
Probability of risk
13 Probabilistic avatars
15 Conclusions and the way forward
Findings
The combined answers to
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