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J R Soc Med. 2001 June; 94(6): 312–313.
PMCID: PMC1281542

Safe Enough? Managing Risk and Regulation

Reviewed by Alan Maynard

Editor: Laura Jones
269pp Price $19.95 ISBN 0-88975-208-7 (p/b)
Vancouver: Fraser Institute, 2000 .

A child with an epileptic seizure is given nitrous oxide rather than oxygen and dies. A patient receives a painkilling drug by the wrong route and dies. Creutzfeldt—Jakob disease stalks the population: the few already affected may prove to be a small advance guard of thousands. Four people are killed in a rail crash in England. Public panic ensues; the rail system closes down for months, forcing people to use road transport, with consequent increases in fatalities which exceed the initial rail mortality.

How can the madness associated with such events (especially in the media) be better managed by policy interventions which are evidence-based? To err is human; this must be accepted. The first person to recycle infected meat products and create BSE may have been stupid but was not an Adolf Hitler.

The contributors to Laura Jones' Safe Enough take a calm and analytical approach to risk management across a range of policy areas from transport to food and Greenpeace. They reject the popular approach to risk aversion, which often implies that death can be avoided for ever. The central issue is how safe is safe enough? The authors emphasize that this question cannot be answered from the restricted perspective of scientists and doctors. It concerns the costs and benefits of alternative interventions.

In Britain fire precaution policy in hospitals is the product of a committee receiving advice from architects and fire officers. The firemen want to reduce fire deaths irrespective of costs, and the architects like to help them by designing expensive escape routes. Such interventions save few lives at high cost: they are poor value for money. If these resources were used to fund coronary artery surgery, more lives could be saved and there would be funds left over to reduce waits for hip replacements and cataract removals. So the policy imperative is to ‘ride’ media nonsense and emphasize that all risk-reducing investments are costly. The challenge is to identify which investments give benefit (e.g. lives saved) at least cost. If funding is focused on such interventions, we will achieve the greatest benefit (most lives saved) from the available budget.

Well that seems logical, doesn't it? So why do so many people rush to prevent future tragic errors with little thought to the benefits and costs of the investments advocated? One contributor, Tammy Tangs, reports the methods and findings of the Harvard Life-Saving Study. This study found no relationship between cost effectiveness and the implementation of life-saving intervention overall; and the appraisal of government regulations again showed no correlation between cost effectiveness and implementation. Thus decision-makers prefer to be inefficient and to waste society's resources. The authors of this nice book do not address such issues extensively. They provide good reviews of existing knowledge and of the failure to confront evidence on the costs and benefits of alternative interventions. But we still do not know how to stop politicians and civil servants and myopic ‘experts’ from wasting the community's resources on pet interventions. Why does the economic perspective continue to be ignored? Perhaps it is because we economists are such mild quiet guys.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press