We review four case studies in which there is a risk of extinction or severe reduction in highly valued species if we ignore either, or both, of two ecosystem control options. "Symptomatic control" implies direct control of extinction risk through direct harvesting or culling of competitors and predators. "Systemic control" implies treating the causes of the problem that led to an unnaturally high abundance in the first place. We demonstrate, with a discussion of historically observed population trends, how surprising trophic interactions can emerge as a result of alterations to a system. Simulation models were developed for two of the case studies as aids to adaptive policy design, to expose possible abundance changes caused by trophic interactions and to highlight key uncertainties about possible responses to ecosystem management policies involving active intervention to control abundances. With reasonable parameter values, these models predict a wide range of possible responses given available data, but do indicate a good chance that active control would reverse declines and reverse extinction risks. We find that controlling seal (Phoca vitulina) populations in the Georgia Strait increases juvenile survival rates of commercial salmon (Oncorhynchus spp.) species, but that commensurate increases in hake populations from decreased seal predation could be a compensatory source of predation on juvenile salmon. We also show that wolf (Canis lupus) control and moose (Alces alces) harvest bring about a recovery in caribou (Rangifer tarandus caribou) populations, where simple habitat protection policies fail to recover caribou before wolf predation causes severe declines. The results help address a common problem in disturbed ecosystems, where controlling extinction risks can mean choosing between active control of species abundance or establishing policies of protection, and allowing threatened species to recover naturally.