Health and the public good

Edited by Scott C Ratzan

UCL Press 247 pages pounds14.95

The picture of the then Conservative agriculture minister, John Gummer, feeding his four-year-old daughter Cordelia a beefburger will always be an abiding image of establishment complacency and cynicism in the BSE crisis. It emerged later that Mr Gummer's accomplice in this shameless publicity stunt was The Sun newspaper.

As Ms Gummer was reluctantly nibbling away, the British public was being fed a diet of misinformation about the absolute safety of British beef and the impossibility of mad cow disease spreading to humans.

That was in 1989. Seven years, and countless soothing ministerial statements later, the public relations facade crumbled. In March 1996 the Spongiform Encephalopathy Advisory Committee decided that there was a potential link between mad cow disease and a new strain of the human brain disease, Creutzfeld- Jakob disease.

The worst-case scenario suggests that up to 85,000 people may die in what former prime minister John Major described as 'the worst crisis a British government has faced since the Falklands'.

He may have seriously understated the position. We do not know, as it can take up to 20 years for the incubation of the disease. Uncertainty, as this excellent book graphically shows, has been a commodity in plentiful supply throughout the scandal. As Joan Leach, a lecturer in science communication at Imperial College, wryly observes: 'Being uncertain has gradually become the mark of the respected scientist.'

Professor Tim Lang, director of the centre for food policy at Thames Valley University, suggests that it was the 'certainty' of government statements claiming absolute safety alongside the strengthening of regulations, like the removal of specified bovine offal, which created 'mixed messages', deeper uncertainty and the collapse of consumer confidence.

Professor Lang proposes increased consumer involvement, as does King's Fund head of communications Ian Wylie, who challenges the present distribution of power and influence in the NHS. He asks provocatively: 'Surely we have to disempower the health service itself?' He adds that real partnership 'must mean being able to say that it is the people who must choose the values which underpin healthcare... and it is the legislators and the managers who must rediscover their roles as servants of the people'.

In a chapter entitled 'The Politics of BSE: negotiating the public's health', the UK government and the European Union are said to have sought the same goal of 'not necessarily protecting public health, but restoring consumer confidence'. With scientists with objective knowledge 'relegated to the laboratory', the Major government 'turned what should have been a medical/health problem into a political one'.

Liberal Democrat health spokesman Simon Hughes says the UK government should follow Sweden's example by setting up a National Institute of Public Health, 'whose main task is to engage in health promotion and disease prevention in close collaboration with national and local authorities as well as popular movements'.

Dick Mayon-White, a consultant in communicable disease control with Oxfordshire health authority, bemoans the separation of health and food safety authorities at local level: 'The responsibility for food safety should be changed to lie with a single government department which is exclusively committed to human health.'

The great strength of this book lies in its multidisciplinary approach and breadth of scientific and historical analysis. It draws on the experience of leading academics in Europe and the US and includes contributions from vets, politicians, journalists, policy-makers and public relations experts as well as representatives of the beef industry.

While the diversity of the contributions helps to tear away some of the mystery - much of it created by politicians - about BSE, the book tackles wider issues such as the public's perception of science, relations between the scientific and non-scientific communities, the need for environmentally sensitive farming and how scientific information should be handled in an era of instant global communications.

Harnessing the new media technologies to develop an effective risk-management strategy is a recurring theme. A survey of the press reveals how inaccurate reporting fed anxiety in a public distrustful of a government which had withheld scientific reports. 'By withholding information, the British government tried to protect the public from unnecessary fear. Instead, it created a crisis which fostered even greater fear. The press eagerly filled the information void and fuelled the crisis.'

Because it helps to fill that 'information void' and challenges the authorities to learn the vital lessons of the BSE crisis, this book should be required reading for those in government, the health service and the scientific community charged with preventing such a debacle in the future.