Our knife-edge decisions

IT IS two-and-a-half years since we gave up beef in my household, shortly after the Government announcement of 20 March 1996 about the link between BSE and CJD. It was against my better judgment, but the family prevailed. I argued that, on the best available advice, beef was safe. They argued that the experts could not be trusted. So we substituted lamb mince for beef - which means that we may have avoided BSE but will now drop dead from heart disease because lamb contains dollops of extra fat compared with beef. We ate pigs, we ate chickens, but cows were off the menu.

Gradually, as in many households, beef has made a limited comeback. We now cook the odd Sunday joint, the occasional spaghetti bolognese made with the proper ingredients. But in the wake of the latest revelations about disagreements at the highest levels of government over the seriousness of the crisis, I am squaring up to resist another assault on our domestic shopping list. It does look, after all, as though we just cannot trust the experts.

Or does it? The latest spat between the Government's former Chief Medical Officer (CMO) and its Chief Veterinary Officer reflects the difficulty of making judgements about risks at the frontiers of science, where knowledge is limited but advancing all the time. Equally, it reflects the difficulty of balancing the needs of one constituency - consumers - with the needs of another - the agricultural industry. Sir Kenneth Calman, the Government's former CMO, declares himself astonished at the casual attitude taken by the Chief Veterinary Officer, Keith Meldrum, to the breaching of government guidelines on removing offal that could transmit BSE from carcases. In four cases, it appears, the spinal cord had been left intact, a discovery Mr Meldrum described as "disappointing".

That was not good enough for Sir Kenneth who felt it fatally undermined the reassurances he had given that BSE could not enter the human food chain as a result of the Government ban on "specified bovine offals" - including the brain and spinal cord - introduced in 1989.

The disagreement between Sir Kenneth and Mr Meldrum reflects their differing responsibilities - to the health of the nation and of the farming community. As Sir Graham Hart, former permanent secretary at the health department, observed at yesterday's sitting of the BSE inquiry, where human health is concerned it is essential to proceed with caution. But caution cannot sensibly mean taking disproportionate action with no regard to its expense or consequences.

Clearly the agriculture ministry should have policed more effectively the government ban on allowing potentially BSE-infected material to be consumed by humans - and should have taken decisive action when it was shown to have failed. But if it underreacted here it would have been equally wrong to overreact by authorising the slaughter of the entire British herd, as has been demanded by some scientists over the last decade on the basis of no sound scientific evidence whatever. Because their guesswork, by chance, subsequently acquired some scientific basis, they have gained credence that they never deserved.

What the BSE inquiry has already exposed is the difficulty of making these decisions, which confront us in every area of life. Take blood. The discovery of new viruses, including HIV and hepatitis C, over the last decade have threatened the future of the National Blood Service to which thousands of patients owe their lives every year. Blood is now screened for HIV and hepatitis C, but new viruses are emerging for which screening, if it can be developed, will cost millions.

A senior health department official told me that one option with a virus expected to infect very few people would be to abandon efforts at screening, and instead expect to pay compensation to those who succumb: the sums would be large, but the total bill would be much lower than the cost of screening.

That may strike many readers as the kind of cold calculation, devoid of humanity, that could be dreamed up only by a faceless bureaucrat in a remote Whitehall department who has never met a haemophiliac dying of Aids caught from infected blood or a family bereaved by beef-linked CJD. (The official in question in fact spent much of his professional life dealing directly with such people.) Yet these are decisions about risks with huge financial implications that cannot be shirked. They require careful judgment guided by science and tested against the public will.

There are many other examples of this kind of balancing act. Reducing or eliminating risks invariably involves an opportunity cost - a raised risk elsewhere. It is arguable, for instance, that the BSE crisis has caused more deaths of farmers by suicide than of beef-eaters by new variant CJD. However, we do not yet know how deaths from CJD will escalate in the future and it may be that people are more prepared to accept a risk over which they have a measure of control (suicide) than one over which they have none (CJD).

An intriguing judgement of this kind relates to the fire regulations in hospitals. Years ago at the height of the asbestos scare - a scare in which the risks to domestic consumers were overplayed, as later experience showed - a senior official in the Government's Health and Safety Executive sought to illustrate the meaning of "opportunity cost". He observed that if the NHS fire regulations were relaxed - meaning fewer fire doors in hospitals - and the money spent instead on treating patients, more people would die in hospital fires but there would be a net saving of life. A judgement had been made that, while people were prepared to accept the risk of dying in hospital, they would not want to die in a fire.

A similar decision was made by the Dutch factory inspectorate faced with an application by the chemicals industry to permit the transport of toxic substances by road. The industry claimed that an acceptable risk of an accident involving leakage of toxic chemicals ought to be one in 10,000, on the basis that this was the risk of the dikes in another part of Holland being breached by the sea.

However, their decision was overruled by the inspectorate, which considered the risk of a chemical spillage too high. An injury that was God-made was more acceptable, they reasoned, than one caused by the hand of man.

The public perception of risk preoccupied Sir Kenneth Calman for much of his seven years at the health department, until his retirement last month. Yesterday, at the BSE inquiry, he stressed that when he said beef was safe he did not mean that it carried "zero risk".

No human activity is free from risk and within the context of the risks that we routinely accept each day - crossing the road, travelling by car - eating beef was no better and no worse.

That is the line I shall be taking with my family. Most risks in life are impossible to quantify and nothing is risk-free. Open the fridge and perils (so-called) lurk on every shelf - salmonella in the eggs, listeria in the cheese, pesticides in the lettuce. Bacon is linked with cancer and phthalates fester in the baby milk.

Changing behaviour involves substituting one risk for another.

Risk-free eating is not an option.