Examination of Witnesses (Questions 160
- 168)
WEDNESDAY 24 FEBRUARY 1999
PROFESSOR T H PENNINGTON
Audrey Wise
160. Going back to the sporadic outbreaks
first of all, you quite rightly said, Professor Pennington, in
response to Howard Stoate earlier that you were not proposing
that everybody who reports to the doctor with a food poisoning
episode should have a sample of diarrhoea sent off to the laboratory
and I think GPs would agree with you that that is no use and impossible
and not a good use of resources. However, do you think it would
be possible, do you think if this is the sort of thing that the
FSA should do and could do within its remit, to, for instance,
design a study taking perhaps two areas, I do not know, to get
it randomised and controlled where for a given time, cases which
present would have a sample sent and perhaps alternate ones or
in neighbouring areas or something of this nature, and perhaps
alternate ones would be the thing in a given area, so as to increase
the stock of knowledge so that then that advice could be given
which then could be more generalised? Do you think that is the
sort of thing?
(Professor Pennington) It is just the sort of
thing where the FSA would probably commission people to do this
kind of study. It may choose to do it on a regular basis to follow
trends, but if we had the case I was talking about earlier, that
would probably be sufficient in itself to do that and then every
now and then. One would do this kind of study to find out what
the true level, as it were, of infection was rather than just
the number of laboratory-reported cases which, as we know, is
a gross underestimate.
161. So, in other words, the choice is not
between we cannot do anything because obviously sporadic things
are difficult because they are sporadic and you cannot chase everything,
or we will chase everything which is impossible, and the choice
is not really between those two things, is it?
(Professor Pennington) No.
162. Could I come back to risks and benefits.
In clause 19 there is talk about taking account of the nature
and magnitude of any risks to public health and also the likely
costs and benefits of the exercise of any function. It strikes
me that risks and costs and benefits, an evaluation of those could
depend very greatly on both views and viewpoints.
(Professor Pennington) Yes.
163. I have written in the margin here "whose:
whose risks, whose costs, whose benefits". Do you think that
the structures and guidance within the FSA would come down more
or where do you think it should come down? It is not just a question
of magnitude, is it, it is a question of whose ideas of magnitude?
(Professor Pennington) Yes.
164. Will there be tensions? Will they be
resolvable?
(Professor Pennington) I think there will be tensions
because everybody has their own pet problem, as it were, which
they see as being of particular importance in terms of public
health. They will press their case very hard and they will have
data to support it. You can cost an outbreak of food poisoning
and it comes out usually at really a rather large cost because
if you take in the time off work and loss to the Exchequer and
that kind of thing, the cost mounts up very quickly. I have a
doubt as to how good those estimates are, they are often very
large. As soon as you move away from the cost of the laboratory
media and the GP's time you move into extrapolations and estimates
which can be very difficult. Nevertheless it is possible to do
costings and justify cases but I would hope that this is not something
which is going to dominate the thinking behind the FSA. I think
what should dominate the thinking is the protection of the public
health in a reasonable sort of way so that we are preventing the
common problems with the highest priority, we are also preventing
the severe infections which perhaps are less common with also
high priority. It will obviously have to prioritise the way it
works but it will use the public health, the protection of the
public health, essentially as its first line of thinking and obviously
if costs are going to be incurred which are very great then you
would start looking to see what you are going to prevent by doing
whatever you are proposing.
165. On the question of risks, we have a
couple of examples talked about quite a lot, the green top milk
and the beef on the bone. I think that it should be possible to
make a distinction in practice between risks which are individual
risks—if I go and I choose to drink green top milk and it
is properly labelled, that is something which affects me—and
the difference it seems to me between that and individual informed
choice and something which I do not have control over. I do not
have control over if the BSE stuff is in the food chain and so
that is where I have to look to other people to protect me. The
same, of course, can be said with genetically modified foods.
Do you think there is a valid distinction there and that it is
reasonable to allow more choice when it can be put on an individual
basis but have more regulation and more precautions when it is
something which would affect people widely and over which they
have no control?
(Professor Pennington) Yes. I think there are
two issues there. One is that I think people perceive a risk to
be very great if it is an involuntary one. They put a magnifier
on the actual risk and say "If it is an involuntary risk,
to me that is a serious problem". Even if the actual risk
of dying is very low they will magnify that up. I think that is
the issue with the GM foods, one does not know whether one is
eating it and so, therefore, one has a perception of risk which
may be unjustified in terms of the actual numbers which come through.
The other issue is that I think one has to take into account the
fact that if one is going to prohibit something it will not necessarily
just be to the individual, I think the green top milk could be
an example here where it could be fed to children, for example,
who in a sense will then be receiving it involuntarily even though
it has been bought by deliberate choice by the parents. I think
there is a wider public health issue there about protecting people
particularly at risk from some of the pathogens that could well
be in green top milk. I think it is a slightly broader issue than
just looking at the individual, you have to look at the general
public health issues that are raised by a particular problem.
I think each problem will probably have almost unique facets to
it. Each one has to be taken on its merits. I think, for example,
that fancy cheeses and listeria can cope very well by labelling
and advice to high risk groups because most of the public are
not particularly at risk from that. There are one or two people
who are and that problem can be resolved through that choice route
but taking into account the full public health considerations.
166. It seems to me not unreasonable that
people resent more deeply risks over which they have no control
because you cannot make your own choice.
(Professor Pennington) Yes, it is a given fact
that is the way people behave I think.
167. The other thing where they might leave
it to somebody else, and you could say because you should not
now eat raw eggs that since a mother might, as I was able to do
with my children, give them raw eggs and milk if they could not
eat anything you cannot do that now, but nobody would say that
because I might still do that with my grandchildren, therefore
we ban the sale of eggs.
(Professor Pennington) No. I think you try and
influence the TV chefs to run a programme about how to cook eggs
properly, that is the way forward with that particular issue.
Audrey Wise: Yes.
Chairman
168. Finally, could I ask you, Professor
Pennington, what you think as an individual the priorities for
attention ought to be in the early days of the Food Standards
Agency?
(Professor Pennington) Well, clearly it has got
to think of how it is going to get public confidence back in a
government department that is responsible for food safety, and
I think it has to be seen to be doing things which are in the
public interest. I think from the technical side, there are some
issues that it could address very early which are going well already,
and I think that would help, like, for example, the issue of Salmonella.
The Salmonella contamination of chickens is coming down
very fast. So if it got on to that particular bandwagon and helped
all those people who are involved in that, that would be a relatively
easy technical task for it to get involved in where it would have
a good news story to tell, without being cynical about it, but
it would obviously have to address the issue of how to have a
dialogue with the public, as it were, for example, over this issue
of perception of risk, so it is not going to be an organisation,
I would hope, that would be driven purely by technical issues
about the microbiological safety of food, but it would have to
take into account some sociological aspects as well as to how
it could have this dialogue with the public and at the same time
showing that it was aggressively going out and making sure that,
for example, the enforcement of food law was being done properly
and appropriately, helping the local authorities there, not coming
down hard on them, but helping local authorities to do that. So
it would have a range of tasks which it would have to get on with
very quickly in order to get public confidence back, which would
take quite a long time, I think.
Chairman: Could I
thank you very much indeed for appearing in front of us this afternoon.
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