Expert View: We're tangled up in warning labels

Society is becoming a "democ- racy by disclosure", to borrow the title of an excellent book by the Harvard academic Mary Graham. In other words, regulators increasingly ask public and private sector bodies to give people the full facts, so allowing them, in theory, to make a rational choice.

Thanks to the internet and 24/7 news, we are all inundated with information. In the UK over the past few months, there have been calls from the Food Standards Agency that food should be better labelled, and soul-searching in the NHS over how medical errors should best be communicated to patients - something that will be discussed at next week's Patient Safety 2004 meeting in Birmingham.

In sum, should risk issues - health, environment or food - be viewed the same way as school league tables? Should, in effect, risk communication be outsourced from regulators to the public and stakeholders? The jury is still out on this. There is no real optimum level on how much detail one can or should provide, and it may actually be counterproductive to put all possible information about all possible risks on warning labels or the internet.

The main justification for this supposed outsourcing is that regulators think they are no longer trusted and hence any top-down form of risk communication is meaningless. From the government's perspective, it also convenient to put the onus on industry to develop appropriate warning labels and the like. However, a number of issues need to be addressed.

For a start, the argument may be a bit too simplistic. Approximately 5 per cent of the general public read warning labels, be they on pharmaceutical products or foods. So informing people via labels, rather than proper, thought-out regulatory strategies, may not be the right answer.

Up to 60 per cent of the general public in this country, and similar numbers of the public abroad, do not take the medicine that is prescribed to them in the correct way, even if they have been given ample warning of the consequences of not following the instructions fully. Individuals halt their antibiotics courses early as they start feeling better; they get confused over what pills should be taken at what times; and there is often a language barrier.

Aside from the obvious issues - such as the health risks attached to the excessive intake of sugar and junk foods - how can one develop proper food warning labels in today's environment where scientific evidence is changing yearly if not monthly?

If one looks at this historically, there was at first a general concern that all fats were bad for you. Some time later, saturated fats were considered bad, and today researchers are mostly concerned about so-called trans fats. Frankly, I do not know the difference between saturated and trans fats. I wonder how many people do? As a result of these developments, should bacon, for example, be continuously relabelled? What confusion would that cause?

If we are unable to challenge the latest political wisdom on labelling, the least we can do is to make the labels themselves simple, readable and coherent. However, better still would be to embark on an education programme for risk communication in the medical field - aimed, for example, at regulators, pharmacists and doctors, enabling them to keep their patients better informed about how they should take their medicine.

Training in proactive risk communication will in the long run be a more efficient use of government spending than trying to outsource the task to an increasingly stressed-out and overworked patient/consumer.

Ragnar Lofstedt is professor of risk management at King's Centre for Risk Management, King's College London.