Threats to Public: Officials Weigh ‘Acceptable’ Risks

For F. David Mathews, the last few weeks’ headlines over Alar-treated apples and cyanide-laced grapes seem agonizingly familiar.

Mathews was the secretary of health, education and welfare who helped make the fateful decisions to urge widespread public inoculation against a possible swine flu epidemic in 1976--inoculations that themselves claimed six lives even though the epidemic did not materialize.

“The pressure of responsibility for the health of the nation is not anything that anyone is going to take lightly,” he said last week. “You feel an enormous amount of responsibility.”

Unfortunately, both former officials and academic experts agree, the need to make quick judgments about matters of public health and safety is a responsibility that officials--and society at large--are often ill-equipped to handle.

With few established criteria to guide them, officials find themselves making ad hoc decisions that carry serious risks and costs whichever way they go--endangering the public if the officials do too little, inconveniencing and sometimes even harming the public if they do too much.

“The hardest decision” a policy- maker faces, said former Food and Drug Administration official Wayne Pines, “is to decide when you have enough information to order a public warning.”

The tough question for policy-makers is often not the factual one of whether any risk exists at all. Instead, the difficulty lies in the moral and political question: which risks are acceptable?

And the problem is increasing because the kinds of situations that require such decisions appear to be arising more frequently. Even as society has become more sensitive to risks and technology has increased the ability to detect threats, gaps in knowledge have left officials--and the public--with few tools to analyze which threats are meaningful or how best to respond to the inescapable ambiguities.

Things were difficult enough when the threats at hand were primarily natural in origin--botulism in canned goods, outbreaks of disease and the like. Today, experts are increasingly concerned about the possibility of a new wave of “economic terrorism” directed against the nation’s infrastructure, ranging from its food supply to its transportation network.

So now in addition to weighing traditional costs and benefits, officials must also weigh the danger that their reactions, even when appropriate to a given threat, may prompt “copy-cat” acts by highlighting the nation’s vulnerabilities.

Other Cases

Beyond the Chilean fruit problem, other cases in point:

--A respected environmental group denounced as a carcinogen a chemical used to control the ripening of apples. Other scientists said the risk had been drastically exaggerated. Should officials ban the chemical while the dispute is sorted out? On Thursday, the federal government formally declared apples safe to eat, but not until panicked school districts across the country had banned apples from their schools.

--Medical researchers investigating viruses warned that a new strain of flu could cause thousands of deaths. They also warned that the vaccine could cause side effects. Should the government urge widespread inoculation? President Gerald R. Ford, acting on Mathews’ advice, did, but the predicted epidemic never materialized. And at least six people died of vaccine-induced paralysis.

--A caller threatened that a bomb would be placed on an unspecified airplane. Past calls had been hoaxes. Should the threat be publicized? Should flights be canceled? Officials did neither, and 270 people died last Dec. 21 when a bomb destroyed Pan Am Flight 103 over Lockerbie, Scotland.

Increasingly Complicated

Condemned when they overreact, excoriated when they are too slow, officials face an increasingly complicated set of pressures and often must make decisions in the midst of tremendous uncertainty.

The events of the last several weeks underscored the difficulty of those decisions. Although the controversies over Alar and Chilean fruit differ substantially in several ways, they posed similar dilemmas for policy-makers.

The Chilean case began on March 3, when an unknown person called the U.S. Embassy in Santiago, Chile, saying that fruit exports from Chile had been poisoned. The warning was first dismissed as a hoax, but after the caller repeated his threat, federal officials stepped up inspection of fruit shipments and, on March 11, discovered two grapes tainted with small doses of cyanide at the port of Philadelphia.

The next day, the FDA ordered all Chilean fruit impounded, advised grocers to remove it from their shelves and told consumers to throw away whatever they had at home. After a week of inspecting 13,000 crates of fruit, no more poison has been found.

The result has been a severe disruption of the economy in Chile, a South American nation whose transition to democracy the United States has been trying to support. Here at home, the ban is likely to end up costing producers, warehousemen, wholesalers and retailers millions of dollars. Over a longer period, fruit producers both in Chile and in California fret that the public may forever retain at least some suspicion about the safety of their products.

But while FDA officials say they “agonized” over their decision, there was little doubt which way they would come down, said Peter H. Schuck, a former senior official in the Jimmy Carter Administration who now teaches at Yale Law School.

“What’s uppermost in their minds,” he said, “is avoiding some great tragedy that will result in the visible poisoning of people and be front-page news.

“In balancing risk and benefits,” Schuck said, a bureaucracy “tends to be dominated by that specter.” The risks, if they materialize, involve specific individuals who are harmed. The benefits of the threatened product are almost always diffused through an entire population. Given that choice, Schuck said, a bureaucracy--especially a medical bureaucracy--will almost always react in favor of maximum safety.

And that tendency has only been strengthened by the vivid example of December’s Pan Am bombing. Officials did not publicize a threat and have now been blamed, at least by families of the victims, for contributing to innocent deaths.

In the end, Pines said, “public health officials have to err on the side of public health.”

More Complex Dilemma

By contrast, the controversy over Alar posed a far more complex dilemma, said Mathews, who as the head of the Charles F. Kettering Foundation in Dayton, Ohio, spends considerable time studying public officials’ response to such questions.

The case began with a respected environmental group, the Natural Resources Defense Council, which has been a leader in the campaign for tougher federal regulation of pesticides and which has been trying for years to persuade the Environmental Protection Agency to ban Alar.

Alar is the trade name of daminozide, a chemical that makes apples stay on the tree longer, keep better in storage and look redder on grocers’ shelves. In large enough doses, it may increase a person’s risk of cancer. Once widely used, it is now applied to only about 5% of the nation’s apple crop.

Having failed to persuade the government to ban the chemical, the NRDC earlier this year decided to mount a public campaign. It issued a report on Alar which, three weeks ago, became the subject of a report on CBS’ “60 Minutes” program. The environmental organization also helped form a group called Mothers and Others for Pesticide Limits, headed by actress Meryl Streep, who has spoken out widely to publicize the case against the chemical.

The result was a campaigner’s dream--a ferocious public reaction that caused school districts around the nation, including scores in Southern California, to ban all apples and apple products whether they contained Alar or not.

Apples will begin reappearing in Los Angeles-area schools, and in districts elsewhere in the country, this week--following a declaration from Washington that no threat to children’s health exists. But where traditional lobbying had failed, the NRDC’s publicity campaign probably will have succeeded: Growers are now likely to abandon the chemical entirely despite the statements by state and federal officials defending it and pronouncing the nation’s apple crop safe.

Defend Their Actions

NRDC officials strongly defend their actions. “Legal food ought to be safe food,” said NRDC spokesman Paul Allen. “We shouldn’t ignore the fact that there are a lot of sectors in American agriculture that rely heavily on chemicals that are designed to be very potent toxics.

“At some point, you have to tell people,” he said. “I don’t apologize for that at all.”

Perhaps one measure of the NRDC’s success, and of the deep-seated nature of public anxiety about toxic substances, was provided inadvertently by President Bush. Even as officials of his Administration were struggling to reassure consumers about Alar and apple products, the President confided to reporters that he himself had switched to carrot juice.

The NRDC’s opponents, however, have criticized the anti-Alar campaign. California Health Services Director Kenneth W. Kizer, for example, recently referred to the removal of apples from schools as “hysteria” and argued that any risk from Alar is far outweighed by the health benefits of eating fruits and vegetables.

What makes such disputes “difficult from a policy point of view,” Mathews noted, “is that the average citizen is sitting there saying: ‘Who am I to believe?’ ”

Disputes such as the one over Alar are usually presented as technical and scientific disputes--”battles of the experts”--while in fact, Mathews said, they really are “moral disputes--what should I do?”

In the case of Alar, for example, there is near-universal agreement that daminozide can cause cancer in a high enough dose. There is also little doubt that the smaller the dose, the smaller the risk. What is not known--and what may never be known for daminozide or any other carcinogen--is whether at some point the dose becomes small enough to eliminate the risk entirely.

Prevailing public policy says there is no such thing as a safe dose of a cancer-causing substance and therefore any detectable amount should be considered dangerous. But, noted Schuck, “when I was doing public interest work in the early ‘70s” as head of Consumers Union’s Washington office, the state of technology was such that “one part per million was the threshold for detection. Now, one part per trillion is measurable.”

Smaller Amounts

As smaller and smaller amounts of potentially dangerous substances become detectable, more and more products become subjects of concern.

“But,” Schuck said, “no one in public life wants to make sensitive judgments on risks and costs when they know the assumptions on which those judgments are based are very fragile and can’t really be defended.”

The result, Mathews said, is “an extreme impasse within our policy-making system.”

Policy-makers ultimately try to make the decisions that they believe the public itself would make if it had the available facts. But in controversies such as this one, the public’s “massive undereducation and inattentiveness to science” make that goal nearly impossible, said Gerald J. Holton, professor of physics and the history of science at Harvard University.

Officials Poorly Advised

The public, Holton noted, is perfectly capable of evaluating scientific controversies when they are presented in an understandable manner, but that seldom is adequately done. Moreover, he said, government officials themselves “are very poorly advised in science and technology.

“In most policy questions, we’re not that vulnerable to experts, we’ve had experiences” that can be used to form judgments, Mathews said. But in disputes such as those over the safety of chemicals, “we are dependent on experts, and there is disagreement among the expert community.”

And as the frequency of such disputes increases, he said, “our normal ways of deciding things are going to need some assistance. I don’t think they’re going to carry the load.”