Human health and endocrine disruption: a simple multicriteria framework for the qualitative assessment of end point specific risks in a context of scientific uncertainty.

Endocrine disruption remains one of the most controversial contemporary environmental issues. While the desired level of protection is ultimately a societal choice, endocrine toxicity could result in a wide spectrum of adverse health effects. Although the application of the causal framework of weight-of-evidence approaches to complex toxicological issues has incited much interest, no international criteria or guidance have yet been developed. In this context, the evidence on end point-specific risks to human health contained in the International Program on Chemical Safety Global assessment of the State-of-Science on Endocrine Disruptors report was updated and assessed qualitatively using three simple criteria relevant to the practical application of the precautionary principle (PP): incidence trends, association, and consequence. The current degree of knowledge was then ranked according to ignorance, uncertainty, and risk. The main sources of scientific uncertainty in relation to incidence trends were associated with the evolution of diagnostic criteria or diagnostic tests, while genetic susceptibility is often proposed as an explanation for the wide geographic variations in the incidence of some diseases. Such genetic polymorphisms are also offered as a potential explanation for some of the inconsistent findings or lack of clear dose-response gradients described under the association criterion. The methodology yielded a relative paucity of data addressing directly the impact for adverse human health effect from both individual and public health perspectives. Results are discussed within the context of the application of the PP. Within a participatory context, this simple framework could provide a useful decision-making tool to both communicate scientific uncertainty to the wider public and manage uncertain risks.