ARisk,

ModernReason

Three R'sand Relevancy

Richard L. HallMcCormick & Company, Inc.

11350 McCormick RoadHunt Valley, Maryland 21031

In these remarks, I would like you to think with me aboutour attitudes toward risks - risks both near and remote, both realand imaginary. These involve problems which reach throughoutsociety, but which affect especially the food field. One canthink of an almost endless number of examples to illustrate andidentify them.

_ We have foundations for such relatively rare diseases ascystic fibrosis and multiple sclerosis. This is well and good;yet we in the United States have done very little that iseffective to reduce the 56,400 automobile deaths per year.We have done even less to reduce the role of alcohol whichis the cause of at least half these deaths, in spite of theexample of several European countries which have takenstringent and clearly effective action.

- We ban or move to ban DDT, but we replace it withdemonstrably more toxic pesticides with which we haveless, and less favorable human experience.

- We frequently see the example of devoted parents who,not wishing to leave their children orphaned in a hazardousworld, fly to the West Coast in separate planes, but thendrive in the same car on the Los Angeles Freeways.

- Food-borne diseases are a serious cause of lost-time illnessand a significant cause of death, and their occurrence isdirectly proportional to the involvement of non-professionalpersonnel in food preparation and handling. Yet there ap­pears to be far more hysterical concern - among a few ­over the safety of pesticidal residues and food additiveswhich, in terms of human injurY or death from their pres­ence in food, have an essentially unblemished record ofsafety.

- We are experiencing a surge of interest in organic or"natural" foods, in part, because of a suspicion of additivesand processing, in spite of overwhelming evidence thatmany naturally occurring constituents of food are toxic atfar lower safety margins than anv intentional additives.

Clearly, our perception and evaluation of relative risk isout of touch with objective reality. So far as food hazar(Js areconcerned (Figure 1), a recent priority listing mentioned by Dr.Virgil O. Worlic!ca of FDA microbiological, nutritional, environ­mental contaminant, natural toxicant, pesticide residue, and foodadditive - is clearly realistic. Yet, this is certainly not the sequencethat represents legislative interest, regulatory effort, educationalconcern, or the insistent clamor of consumer advocates. It is amorose, but generally accurate observation that, at least in theUnited States, the amount of regulatory and press concern devot­ed to these topics is in inverse proportion to their actual im­p~rtance. You in Canada are to be commended for having re­tamed a higher degree of sanity in these areas than we havemanaged to do. Yet the entire subiect - the technical activity,:egulato.ry r'levelonments, and public reaction - has a heavy,InternatIOnal impact.. Now why should there be these inconsistencies and irrational­ity especially with food? We can assign at least the followingreasons:

1. Food is a "gut" issue. We all must eat. Food is the obiectof our earliest preferences and some of our strongest Drei­irluces. What threatens - or appears to threaten - foodthrreatens us in a very direct and visceral way. '

2. These irrational concerns over food are, in part, protestag~;nst th'l complexity and materialism of modern society.'~Tithollt (JOll"t. thev are, to some extent. a Protest a,g~inst

the occasional dishonesty and misrepresentation we find infood marketing and advertising.

3. The<e inconsistf'Dcies are en('ouraged and played upon forpolitical gain. Food - our largest industry - is certainly

PFresented at the 15th National Conference Canadian Institute ofood Science and Technology, Toronto, Canada, June 12, 1972.

J. Inst. Can. ScI. Techno!. Ailment. Vo!. 6, No I, 1973

the most visible and, in some ways, one of the most vul­nerable segments of our society.

4. A professional establishment which bears considerable re­sponsibility for poor effectiveness of technical communica­tion, whether in fornlal education processes, in helping thelay press, or in their own irresponsible utterances. Forexample,- In view of what is known from recent nutrition surveys,

and the incidence of cardiovascular disease, we certain­ly must admit that we have done a poor job of nutritioneducation at all levels. It is fair to say that nutritioncourses, by and large, are among the least well receivedby students.Professional society assistance to the lay press is restrict­ed in scope, unimaginative, and infrequent.Finally, we have seen a number of recent examples inwhich scientists have, in lay-press comment, expandedon and interpreted their own or someone else's workin a wholly irresponsible manner.

5. We have become familiar with the instant overreactionsyndrome - instant overreaction to unevaluated or imvroper­ly evaluated technical developments. This is perhaps due,in part, to the speed and ease of communication, thereadiness with which one can popularize the sensationalto a public not prepared to react critically, and by mediausually not equipped or inclined to be critical. We shuuld.however, be grateful to, and work more closely with thosein the media who do report these difficult areas responsibly.All of these factors contribute to, but do not wholly explainour current irrationalities. To go further, we need toexamine in some detail the ways in which we regard andchoose among risks and benefits.

6. Our risk-benefit choices are, in part, rational and, in part,irrational, but even when they are the latter, they yield toanalysis which shows what can be done to improve theirrationality.a. We need to recognize what we cannot afford to admit

politically, and even find unpalatable privately; we donot avoid risks, but simply choose among them.

b. That choice is complex and its analysis deserves vastlymore attention and serious effort than it has received todate.

I should like to venture into this area with you this morning.To do so will require defining some words and concepts withconsiderable care. These concepts and the distinctions betweenthem may seem a bit arbitrary or artificial. So also is a molecularmodel. There are few here who really believe that hydrogenatoms are orange balls a centimeter and a half in diameter. Butsuch models help us understand how and why molecules reactas they do. If these concepts defined here help us understandhow and why people react as they do, they will have served theirpurpose.

By "benefit", using the dictionary definition, we mean "any­thing contributing to an improvement in condition." Bv "risk"we mean "the chance of injury, damage, or loss." "Vital" is, ofcourse, "concerne(J with, or manifesting life," and "necessary" or"essential to life.""

A vital risk, then, is a chance of injury, damage, or loss oflife. This includes, of course, great pain and incapacitation. Acharacteristic of vital risVs is that one can measure thpm, butnot in dollars. The additional risk to life of U.S. males posedby the 1918-19 influenza epidemic was a 50 percent increasefrom about 15/thousand to ahout 22/thousand. (Personal com­munication, Dr. James L. Whittenberger, Chairman. Departmentof Physiology, Harvard School of Public Health, Boston, Mas­sachusetts) The risk of fatality in commercial air travel is about

*Webster's New World Dictionnary of the American Language, SecondCollege Edition, World Publlshing Company (1970).

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Fig. 1. Order of priority - adual hazards

0.07 deaths/IOO million passenger miles. That involved in privateautomobile travel is about 4.9 deaths/lOO million passenger miles.We can measure very accurately changes in such vital indicationsas b~ood pressure, hemoglobin, and lung capacity. But we regardit as psychotic and immoral to put a dollar value on them. True,juries do it every day, but as an after-the-fact compensation. Noone ever arranges in advance to sell an ann, or a life. Theserisks are non-pecuniary.

A vital benefit, then, is something contributing to an im­provement in a condition essential to life. Note that we are nottalking about that which is routine, regular, or expected, butabout a change necessary for life. Vital benefits, also, can bemeasured, but not in dollars. All of us remember what inocula­tion has done to remove or enonnously reduce the risks of polioand childhood diseases. \lVe can measure the effect of hypotensivedrugs, and the reduction in an infection due to antibiotic. These,too, are non-pecuniary. Their price has no relationship to theirvalue to one who needs them.

A non-vital risk is a chance of injury, loss, or damage ina non-vital but possibly important way. Loss of comfort orpleasure, inconvenience, frustration, hurt pride are among thenon-vital risks.

A non-vital benefit, similarly, contributes to an improve­ment in these areas of pleasure, convenience, comfort, or egosatisfactions. By contrast, non-vital risks and benefits are usuallypecuniary. We measure the value of avoiding or gaining themin dollars and cents.

Of course, the boundary between vital and non-vital risks ­or benefits - is not always clear. But the existence of boundarycases is no bar to recognizing and dealing with them as differentareas.

As just mentioned, we do not buy or sell vital risks andbenefits for a price which reflects their true value. But we willtrade off or accept a vital risk for an even greater vital benefit.(Figure 2)

Thus, chloramphenicol is still the drug of choice for typhoidfever, even though it carries a substantial risk of aplastic anemia.Thp prosncct of relieving the symptoms of Parkinson's diseasejustifies the risks of the serious side effects of I-Dopa.

Note that our society does not leave these hazard-ladendecisions to the unrestrained choice of the individual. We inserta professionally qualified decision-maker, the physician, into theprocess, and we support and limit him with the apparatus ofthe Health Protection Branch or the FDA.

And even when qualified, there is a self-exclusion. "The

lm"n who is his own doctor has a fool for a patient." This cuts)oth ways. It not only excludes the amateur physician, but ex­dll<ks the qualified physician from serious practice on himselfor hiS. family, where distortions of judgment can easily occur.I (0, .acceptance of vital risks to gain a still greater vital)0U0 It IS entirely proper, if we first provide the legal and

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Fig. 2. Vital risk and vital benefit

moral framework to govern these choices.But we do not only accept vital risks in a "combination offer"

with vital benefits. What is more interesting, and far moretroublesome, is that we also accept vital risks when we believethat we can "manage" them so as to avoid or reduce their impact,or when we think they are too remote to bother about. Just aswe do not place a price on them, neither do we accept themunless we believe that, either inherently, or as a result of ourcapable "management", the risks are too remote to mean any­thing - for example, only a chance in a million, or that ultimatein meaninglessness, one in a "jillion".

It is obvious that our perception of our ability to manage,or of remoteness, may be quite inaccurate. The cemeteries arefull of people who thought they could manage a car, or alcohol,or both, or who thought that the risk of lung cancer was remote.Why should there be these frequent errors of judgment? If weexamine tho~e situations involving no vital benefits, but a vitalrisk, which we accept because we think it is remote or manage­able, we see that each of them involves one or more non-vitalbenefits or risks. (Figure 3) It is the aoquisition of these non­vital benefits or the avoidance of non-vital risks which is theprincipal object of the transaction, and the value of these, inexcess of the price, distorts our judgment. Thus, we can't waitfor sixty seconds, so we jay-walk. Dieting is unpleasant, so welug around those fifteen extra pounds. We so enjoy the thrillof skiing, we are confident we can manage Tuckennan's Ravine.

The risk of automobile accidents is dear, yet we accept themgladly for their convenience and comfort, and the time they save.Yet in this case, the inherent risk to the individual and to othersis simply too large to ignore. Obviously, it is not remote, andtoo many drivers cannot "manage". So in this case - intermediatebetween pres,cription dmgs and a wholly unregulated product ­we license drivers and vehicles, and have an elaborate, if not en­tirely effective array of traffic laws, police, and courts.

To complete the pattern, (Figure 4) there are also situations- often the converse of those we have just discussed - in whichwe accept certain non-vital risks to comfort, pleasure, or con­venience, in order to obtain a vital benefit. It is some sort ofcommentary on human nature that this category of objectively"good" exchanges often has to be forced on us by our physician orthe traffic police.

Finally, there is the categorv of exchanges (Figure 5) in­volving non-vital risks and benefits.

The situation with respect to foods is fundamentally dif­ferent. Within our definitions here, food though a routine neces­sity, is not a vital benefit. For most of us in the developed coun­tries, its wide availability, the lack of urgency in obtaining it,the freedom and variety of choice we enjoy, and the increasingfeeling that everyone is entitled to "freedom from hunger" re­move food from within the definition of vital benefit we haveemployed. Lilre air, food is necessary for maintenance, but itdoes not contribute to an improvement essential to life. Since it

Can. lnst. 1"ood Sci. Techno!. J. Vo!. 6, No.1, 1973

Fig. 3. Vital and non-vital risks

is not a vital benefit, we cannot trade off against it any vital risks;hence, our horror at the idea of any vital risk associated withfood, most especially when we are not able to manage that risk,i.e., to reduce it to insignificance.

On the other hand, if one is starving, the situation changesdrastically. Then food does indeed contribute to an improve­ment essential to life and then is a vital benefit. And in thatsituation, we would accept risks. We would eat from that dentedcan or that doubtful piece of meat. There is no FDA or HealthProtection Branch operating in Bangladesh.

Since food is not a vital benefit, the non-vital benefits as­sociated with it, eating pleasure, convenience, etc., are dominant.This raises the question of how we are to measure and evaluatethese non-vital benefits with respect to food or indeed withrespect to anything else. There are three general mechanisms: (1)administrative decision, (2) public hearing or referendum, and(3) the marketplace. In our society with its democratic traditions,only the marketplace, with all its weaknesses and the obviousneed for some regulation, is a viable and generally satisfactorymechanism. \\'here non-vital benefits are concerned, the bestmethod of determining their value usually is to determine whatpeople will pay for them.

Industry, which offers goods or services for sale, does sobecause it expects that people will be willing to pay for thebenefits these provide. Indeed, it measures the value of thesebenefits beforehand by market research and after marketing bytraditional accounting procedures, such as return on investment.

A regulatory agency, on the other hand, is primarily preoc­cupied with the measurement of risk. Every official knows thathe wiU not be criticized for the unrealized benefit, but that hewill be criticized for any harm - whether real or imagined, andwhether foreseeable beforehand or only by hindsight. Industry,of course, does not wish to engage in the unprofitable develop­ment of goods or services which they wiU not eventually bea?le to market. But if a particular company takes too strict aYlew of risks, it will be at a competitive disadvantage. Hence,mdustry tends primarily to concentrate on benefits although withSU?staJ~tial concern for the risks, whereas regulatory agencies arepnmanly concerned with risks. This separation of role w;th thepressure for decision at two different points by two differentgroups using non-identical criteria produces a tension which isnot wholly bad, but which demonstrablv interferes with in­novation and with adaptation to changed information or cir­cumstances. Worse yet, inadequate public understanding of thesetwo roles leads also to distrust and suspicion of the wholePbrocess. We need to consider what improvements might reason­a ly be made.

bLet us quickly recapitulate. There are vital risks and vital

enefits. These are non-pecuniary. They may be measured butnot in dollars. They may be traded off against each other onlyunder skilled supervision and with proper regard for human

J. Inst. Can. Sci. Techno!. Aliment. Vol. 6, No 1, 1973

Fig. 4. Non-vital risks and vital benefits

values. We as individuals will accept vital risks without morethan compensating vital benefits only if we can "manage" therisks, or if they are so remote so as to be insignificant.

There are. also non-vital risks and non-vital benefits. Thesecan be traded off against each other and sold for dollars. Fornon-vital benefits the best decision mechanism is free choice ina reasonably regulated marketplace. If a non-vital benefit has aperceived value sufficiently in excess of cost, it may well distortour estimates of the remoteness and manageability of any as­sociated vital risks.

Finally, in these terms, food is not a "vital benefit" in oursociety, so we cannot accept with it any vital risks. Hence, oureasy and incorrect assumption that food safety is an "absolute"and our emotional reaction when we are reminded - as by onecase of botulism - that it is not an absolute.

In the evaluation of risks and benefits, the government con­centrates principally on evaluation of the risks whereas industry,while concerned with both, tends to be preoccupied mainly withthe benefits.

It is now possible to look at food safety with more explicitunderstanding of why many consumers and governments reactas they do, so differently from the way reality would seem torequire. (Figure 6) In this array, the risks from environmentalpollutants, from food additives, and pesticide residues whichgovernment, press, and emotional reaction tend to rate high inpriority and concern are so regarded because a number of peoplewronglv view them as vital. More than that, they really cannotbe "managed" by the individual, although the use of so-called"organic" foods is a naive, pathetic, ineffective, and sometimesfraudulent attempt to manage them. Nor are people convincedthat these risks are too remote to worry about. In the first place,the evidence of their remoteness is necessarily negative evidencealways subject to doubt from the slightest shred of positive sus­picion. Furthermore, several people are leading highly con­genial and even profitable careers built on assuring the publicthat these risks are not remote. Finally, consumers generally donot understand sufficiently the value of the non-vital benefitsinvolved in the use of food additives and pesticides to want tojudge remoteness accurately.

Conversely, nutritional, microbiological, and natural toxicanthazards are norn1aJly low in concern, the recent flurry of interestin botulism notwithstanding. They are low in concern becauseof a false sense of security in our ability to manage them andan incorrect estimate of remoteness. We usually tend to regardthese risks either as non-vital or remote, because the cost ofactually avoiding or reducing them is enough to distort our judg­ment. We do not like this or that food. The inconvenience orcost of sanitation is simply too great.

Now let us return to our original list of reasons for irration­ality. In what directions do possible solutions lie?

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hg. b. Non-vItal risks and benefits

1. They lie not in a retreat from science and technology, butin more and better use of it. The answer to unrestrainedpopulation growth is not return to war, pestilence, andfamine, but in improved methods of birth control. Theanswer to increased food production in developing coun­tries is not organic gardening and more manure, but econo­mic development, including all this implies in plant genetics,the use of fertilizers and irrigation, and improved transpor­tation and distribution systems. The answer to automobilepollution is not the horse.

2. Certainly they lie in more effort and responsibility devotedto realistic evaluation of risks and benefits. We need moreexpert support of regulatory agencies, not only to improvethe quality of their decisions but to improve their accept­ance within the scientific community and among the publicgenerally. Perhaps a new mechanism for review and de­cision is necessary. \Ve have to face the fact that regulatoryaction and the legislation behind it are really responsiveto the state of vocal public opinion, whether that opinion iswell or poorly informed. Therefore, a better-informed pub­lic which has a firmer sense of security in and control overits surroundings is necessary. Consumer movements arenot going to go away. We need to make them more in­formed, more rational, and more effective. Several thingscan be done.

There is a real need for some degree of educationalreform not only in terms of greater stimulation andeffectiveness, but also in basic content. As our tech­nological society has developed and as each field in itreaches a certain stage of compiexity, we have tendedto pull all study of it out of our secondary schools andcolleges and have made it a discipline reserved forundergraduate majors, or often for graduate educationalone. This has happened to medicine, yet which of usgoes through life without contact with doctors andhospitals or without taking dozens of self-prescribedover-the-counter remedies. This has happened to ac­counting, and yet, we corporately and individually, arethe prisoners of accountants, ours, or some grey emi­nence somewhere behind a haywire computer. It cer­tainly is true of the law; yet our life is increasingly ruledby detailed and complex developments in these areaswe seldom understand. It is largely true of engineeringand nutrition. We have taught people how to make aliving, but not how to live; how to succeed, but nothow to cope. With respect to risks, we have certainlynot taught them how to "manage" or how to judge im­minence or remoteness. If the old definition of a liberaleducation is sound, that it equips one to make judg­ments outside his field, then really this is what we needa new generation of better-educated generalists; lesssusceptible to misinformation and misunderstanding.

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Fig. 0. neactlOns to tood safety problems.

- We need a better level of restraint, honesty, and pro­priety in the promotion of products. The outright casesof dishonesty and misrepresentation are rare, but theyare distasteful; they are well publicized, and consumersare skeptical and resentful. Full information will nota'ccomplish everything, but it will help. Unfortunately,there is an occasional tendency within industry itself toindulge in cannibalism and by innuendo and misin­formation to take advantage of public concern. In suchcategory belong the yogurt ads which loudly proclaim"no chemical additives", or the vitamin tablets whichproudly proclaim that they contain no cyclamates andcan "only do your children good".Particularly necessary in this age of instant communica­tion and overconcern is a stronger ethical sense and afirmer professional discipline with respect to public dis­cussion of scientific results. In part, this must consist ofmore cautious and restrained discussion of the implica­tions of one's own work and anticipating the fact thatthe news media are likely to ignore any attempts atbalance and to seize only on something that is amusing,colorful, or alarming. But we also need to work throughprofessional societies, such as 1FT, to reserve the trendtoward public discussion before scientific publication.We have seen too much of this compulsion to rushbefore the television cameras dangling deformed em­bryos or before congressional committees with oral re­ports of unpublished research. This is not merely un­professional, but improper in any sense. It avoids theadvantages of peer group review, a bulwark of scientificintegrity developed and accepted over the years. Publicdiscussion before scientific publication prevents one'scolleagues from preparing themselves to take part ininformed discussion. Such behavior is poor science, andis the trademark of the insecure and unprepared.Finally, it is appropriate to mention a new professionallybased consumer information program, announced lastmorrth at the 1FT meeting in Minneapolis. In the past,individual scientists have occasionally marle efforts atincreasing public understanding, but professional so­cieties have seldom done so, except in the slow andindirect way of curriculum changes.With consumer groups and consumer spokesmen bf>­coming ever more active and effective, it becomes in­creasingly necessary to attempt to insure that theirpositions are based on something beyond concern, emo­tion, and inadequate infornlation. As the technical com­plexity of our lives far exceeds the ability of our in<li­vidual understanding to cope with that complexity, widergovernment regulation becomes more necessary andinevitable. Not only from a professional point of view,but as citizens we have a stake in seeing that consumer

Can. Inst. Food Sci. Techno!. J. Vol. 6. No. I, 1973

inputs into that regulation are as well infonned as pos­sible, and that the expertise within the profession onissues of current interest is made available for whateverpublic good it can accomplish. 1FT is responding tothis need with a wholly new, and in some respects,unique program. An Expert Panel on Food Safety andNutrition, a group of distinguished academic scientists,will define areas of significant current and potentialpublic interest and prepare summaries and interpreta­tions of current knowledge and scientific judgment inthese areas of food safety and nutrition.A Committee on Public Infonnation will work withand support the activity of the Panel in defining areasof interest. It will receive the reports of the Panel andrender these into popularized versions which will berechecked and approved by the Panel for scientificaccuracy and balance prior to release. The Committeewill transmit these reports and news releases preparedfrom them to appropriate other organizations and nation­al media. This, though useful, is still far from sufficient.We will also have regional spokesmen for the ExpertPanel - the local eyes, ears, and tongues of the Paneldrawn from members of the 1FT, who will receive boththe technical and popularized reports as background in­formation. A pilot group of these spokesmen, chosenbecause they are respected and capable scientists, arebeing trained and advised in press contacts. They willreceive assistance in meeting key, local members of themedia, such as science editors, food page editors, TVnf'WS commentators, etc. They will be expected (at1FT expense and with some professional PR assistance)to meet with these people on an infonnal, occasional ­but periodic - basis. The concept is to build up a corps

J. lnst. Can. ScI. Technol. Aliment. Vol. 6. No 1, 1973

of regional spokesmen, of whose identity the mediaare aware, to pass information on matters of currentinterest on to the media on the spokesman's own ini­tiative, and to receive and answer questions from themedia. We also foresee, of course, that no spokesman'sexpertise will be broad and deep in all areas, and thathe will inevitably receive questions he cannot answerauthoritatively and immediately. In such instances, hewill place the media representative at once in telephonecontact with an appropriate Expert Panel member. Thelocal spokesman will additionally be expected to reportback to the Expert Panel questions, attitudes, and prob­lems which he encounters, which might well be subjectfor further Panel consideration.If this pilot program succeeds, we can expect to broadenit and involve other societies. The needs is very large ­far too large to be satisfied by 1FT alone. It must notbe solely a fire-fighting effort responding too little andtoo late to crises from without. It must anticipate prob­lems and educate against them beforehand. Ultimately,it must make our professional societies solid and un­biased resources on which the press and consumergroups know they can call.

The risks and benefits with which we shall continue to liveobviously will change, and seem bound to increase in numberand complexity. As scientists and technologists, our concern mustincreasingly be, not just with the risks and benefits themselves,but with helping all citizens and our institutions to cope withthem knowledgeably, constructively, comfortably, and calmly.

Note: The section dealing with risks and benefits has been aidedgreatly' by discussions with and unpublished communicationsfrom Dr. CarlO. Muehlhause of the National Bureau ofStandards. Dr. Muehlhause is not. however, responsible forthis material as presented here.

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