Peter Sinsheimer

It is time to revise our approach to registering antimicrobial agents for health care settings

• In this manuscript, we provide a critical assessment of the process that is currently used by the U.S. Environmental Protection Agency to register antimicrobial products and focus on the recent registration of copper and copper alloys as antimicrobial surfaces.

Advancing Alternative Analysis: Integration of Decision Science

Background: Decision analysis—a systematic approach to solving complex problems—offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals. Objectives: We assessed whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics. Methods: A workshop was convened that included representatives from government, academia, business, and civil society and included experts in toxicology, decision science, alternatives assessment, engineering, and law and policy. Participants were divided into two groups and were prompted with targeted questions. Throughout the workshop, the groups periodically came together in plenary sessions to reflect on other groups’ findings. Results: We concluded that the further incorporation of decision science into alternatives analysis would advance the ability of companies and regulators to select alternatives to harmful ingredients and would also advance the science of decision analysis. Conclusions: We advance four recommendations: a) engaging the systematic development and evaluation of decision approaches and tools; b) using case studies to advance the integration of decision analysis into alternatives analysis; c) supporting transdisciplinary research; and d) supporting education and outreach efforts. https://doi.org/10.1289/EHP483

Public priorities for evaluating air quality management measures

The results of a pilot study of the priorities that concerned parties assign to a number of criteria for evaluating air quality management measures (AQMM) are reported. The analysed priorities were those of the members of: (a) two task forces appointed to assist the implementation of the Air Quality Management Plan of the South Coast Air Quality Management District of California; and (b) the gallery , during the meetings of these task forces. Major findings include: (a) that there is not a single criterion that predominates; (b) the concern that supports the legal requirement for an almost exclusive economic efficiency valuation is not shared by the public; (c) concerned parties with similar special interest affiliations and expertise hold statistically different priorities; and (d) distinct patterns of priorities exist necessitating separate evaluations of AQMM in order better to understand the reasons for support (opposition) of each measure and the strength of this support. An important consequence of these findings is that no charge that air quality management decisions may cater to special interests can be supported. Hence, the challenge emerges for all concerned parties to determine the factors, other than those associated with conventional special interest labels, which actually influence public values regarding air quality management.

Public priorities for efficiency in air quality management

The results of a pilot study of the priorities that concerned parties assigned to efficiency attributes of air quality management measures are reported. The analysed priorities were those of the members of: (a) two task forces appointed to assist the South Coast Air Quality Management District of California evaluate alternative measures; and (b) the gallery , during the task force meetings. Major findings include: (a) a great majority of concerned parties assigned a more than two-times greater priority to the beneficial impacts of measures than to the negative impacts; (b) concerned parties with the highest priority for the beneficial impacts appear to disagree on the priority of specific categories of these impacts; (c) concerned parties with similar special interest affiliations and expertises hold statistically different priorities; and (d) distinct patterns of priorities exist necessitating separate efficiency assessments of measures in order to better understand the reasons for support (opposition) of each measure and the strength of this support. According to these findings, even when efficiency is chosen as the only criterion, a more involved process is needed than a pecuniary benefit-cost analysis. The objective of this process should be a multi-attribute evaluation of air quality management measures with the proactive participation of interested parties. Only such a process can assist conflict management and a more efficacious implementation of decisions.

Public values for equity in air quality management

The results of a pilot study of public values regarding the criterion of equity for air quality management are reported. Values refer to: (a) the priority assigned to equity attributes; and (b) the strength of preference for potential attribute levels. The public for this study was comprised of: (a) the members of two task forces appointed to assist the South Coast Air Quality Management District of California evaluate alternative air quality management measures, and (b) the gallery present during the task force meetings. Major findings include: (a) the concern with the equity of the impact distribution of measures among socio-economic groups is significantly higher to that among counties; (b) the concern with the equity of employment impact distributions is even higher than that of the next value of all impacts for a large number of the study participants; (c) there exist two groups of participants with opposing strong views regarding the priority of all equity attributes defined by the study; (d) there is no unanimous agreement on a monotonically increasing preference for higher equity levels; and (e) the lack of agreement among participants declaring similar interest and expertise affiliations. These findings call for a participatory multi-attribute evaluation of the equity of air quality management measures which will facilitate conflict management and thus a more efficacious implementation.

Response to “Perspectives from the field in response to ‘It is time to revise our approach to registering antimicrobial agents [by the Environmental Protection Agency] for health care settings’”

• We express our satisfaction with the responding authors agreement with our call to action to require clinical studies in the U.S. Environmental Protection Agency registration of antimicrobial surfaces.