Back in 1999, when John Krebs went to see Frank Dobson, then secretary of state for health, about a possible job as the head of the planned Food Standards Agency (FSA), Dobson said, "I can't understand why you would want this job. People tell me it is a poisoned chalice, but I have looked carefully and I can't see the chalice anywhere, only the poison."
Small wonder: Britain was at the time still mired in one of its worst food crises. Despite expert claims that British beef was "perfectly safe," by the end of 2000, more than 80 people had died from vCJD, the human form of mad cow disease (BSE), and the public had lost trust in government and food safety experts.
Krebs, then a research professor in zoology at Oxford University, took the FSA job for a five-year stint that ended in April 2005 (he is now back at Oxford as principal of Jesus College). His five years in charge began with a commitment to bring transparency to this bit of government. But transparency is not always enough. Food is an emotional matter. In 2001, Krebs had to deal with the outbreak of foot-and-mouth disease; in 2004 with claims from scientists that farmed salmon was too dangerous to eat more than a few times a year; and in 2005 with a fight with the food industry over the appearance in food of the banned dye Sudan 1, which triggered Britain's biggest ever recall of food products. In 2003, Krebs launched a campaign to get us to reduce our salt intake and to persuade the food industry to take needless salt out of food. More recently he has opened the debate over whether junk foods should be advertised to children. Along the way he ran into quarrels with the organic and anti-GM lobbies, and faced a swingeing, six-page attack in March 2004 from the Sunday Times Magazine, which claimed that the FSA "pays no more account to public opinion than it might to the clucking of a hen." But opinion surveys show an increase in public recognition for the agency and of trust in its independent judgement during Krebs's tenure.
I asked him about open government, the role of the expert in a world where the public expects its views to count, and whether public policy can help to make ever fatter and lazier Britons healthy and slim.
John Krebs: Several things. One was a perceived conflict between the role of the ministry of agriculture, fisheries and food (Maff) in supporting the food and farming industry and its role in protecting the interests of consumers. There was also too much secrecy and too many decisions made to save political skins rather than to protect the public. The prime minister wanted a fresh start with a clear emphasis on consumer protection, transparency and openness. As for me, I wanted honesty about scientific evidence and what it can or cannot tell us. Scientific experts had not come out of BSE too well. They had allowed the statement that "the risk is remote" to be interpreted as "British beef is absolutely safe."
AA: You told me when you joined the FSA that you were going to be honest about uncertainty, rather than making the usual reassuring pronouncements. I thought you would be squashed by the civil service.
JK: There were two defining events quite early on where we won some battles for transparency. The first was over whether BSE could have jumped into sheep. We decided to hold a press conference at which we would not say the usual, "We have got it all under control and no one needs to worry." Rather, we explained that there is uncertainty, that scientists don't have the answer, but here is our advice in the meantime and here is what we are trying to do to reduce the uncertainty. Could an authority figure get away with talking about uncertainty? Well, it seemed to work and did not create the crisis in the consumption of lamb that Maff had assumed it would.
The second case was in the middle of the foot-and-mouth crisis and provoked enormous pressure from Maff to change course. Many potentially infected animals were being burned on funeral pyres around the country. Dioxins, which can cause cancer, were coming out of the fires and being carried on to grassland where animals grazed and ending up back in dairy products. The question was whether the levels of dioxin were dangerous to health. I put together a group of experts in meteorology, chemistry, plant and animal physiology and so on, and we found that there were huge uncertainties in our estimates of the risk. In the worst case, there could have been a danger to health. So I concluded that we should tell the public that our best guess was that there was a very low risk, but that we were not certain. In the meantime, people who bought milk from farms near funeral pyres might think about switching to supermarket milk. As soon as Maff heard about this, I had ministers on the phone telling me I was about to create a crisis in the dairy industry. When I didn't back down, the line became, "No 10 will be very unhappy about this." But we felt this was a real test case, so we carried on. And there was no crisis.
We also made the decision that the FSA board would discuss and decide on policy in public. The staff had been used to writing papers for ministers that had to be shredded at the end of a meeting. Eventually, FSA board meetings were broadcast on the web so anyone could see policy in the making.
Central government is still very anxious about transparency. I remember a meeting chaired by a senior civil servant who was talking about the need for transparency in government. I said, "I agree with you Richard, so why don't we put the minutes of this meeting up on the web?" He was horrified, responding, "We can't do that, because we are discussing policy here." But the question of transparency should be centred on areas where it should not apply. You cannot be transparent about things like personnel and finance, but many of the issues that are not discussed in public could be.
AA: Openness and transparency is one thing. But there are still scientific experts on one side of the table and the public on the other. And we are living in a time when the public and pressure groups demand ever more that their voices be heard. You provoked much anger from the organic movement when you told them in 2000 that people are "not getting value for money… if they think they are buying food with extra nutritional quality or extra safety" by buying organic. There was a feeling that you were going against the consumer despite your commitment to make the FSA the "champion of the consumer."
JK: The organic issue is complex and has lessons for the relationship between experts and the public. We did learn that we needed to hold some very public meetings right at the beginning of a policy discussion, even before we had really developed our own thoughts. We needed to say: here is something we are thinking about over the next year or so, we want your views now, and as the story develops let's repeatedly engage with the public and the media.
The organic debate took place early in the life of the agency and I think there was a flaw in our process. We just made an ex cathedra statement based on an expert review of the literature. We could have managed it better, but I don't think the outcome would have been different because the scientific evidence does not show that organic food is healthier. It may be better for the environment, but there is no evidence it is better for health.
The deeper question is about what it means to represent the interests of the consumer. What does it mean to talk about "the public" when there are so many differ-ent publics? Figures show, for instance, that only about 5 per cent of shoppers mostly or regularly buy organic food. Price is the main criterion for the vast majority of consumers, which is why supermarkets compete so heavily in this area. Should we just stick up for this majority? Other groups insist we should consume only local food—English carrots, turnips and parsnips in the winter rather than Kenyan green beans or Spanish tomatoes.
There are many different constituencies out there. When you ask the public, the people who are most likely to come forward are, of course, the interest groups. But we can't do what a certain group wants us to do. We have to be objective about the evidence and take an independent view, but in a transparent way that allows public involvement.
AA: I get a little confused here, because although I accept that organic food is not proven to be better for my health, there is evidence, as you say, that it may help the environment. But the FSA is only supposed to comment on health issues, not the environment.
JK: It is the same issue with GM foods. If you ask if GM soya is riskier to human health than non-GM, the answer, as far as we can tell from the evidence, is no, but it doesn't say anything about any environmental impacts that GM might have. Many people probably don't naturally distinguish between "is it safe for my kids?" and "is it safe for butterflies?" But I always tried to be clear that the FSA talks only about human health. This distinction is a feature of the way government is divided up. I guess it comes down to the old mantra of joined-up government. (In my experience, a lot of effort on the part of civil servants goes into actually preventing, or certainly not working for, joined-up government.) The worries we encountered in 2004 about eating farmed salmon were similar, because many people linked worries about the environmental impacts of fish farming with concerns over the human health implications.
AA: Concerns over whether farmed salmon contained dangerous levels of dioxins were compounded because experts themselves could not agree on the risks. So there was yet another level of uncertainty for the public to digest.
JK: It seems a complicated message to get across when the scientific experts disagree, but actually it is not much different from a typical pub conversation on football. Someone might ask, "Are Chelsea going to win next Saturday?" and there will be a weight of evidence that says they will, but someone else might reply that Wigan could just beat them. People can cope with this. They do it all the time. It is about understanding that life is not risk-free, that there are probabilities, and that you have to make judgements based on the weight of evidence.
Perhaps explaining uncertainties and probabilities would have made it easier for the public to deal with the MMR vaccination debate, where a small minority of scientists claimed that the triple vaccination could cause autism. There are outliers in any debate and we cannot always say they have got it wrong, but we can say where the centre of gravity of opinion lies. Instead of saying MMR is absolutely safe, the department of health could have said: we cannot guarantee absolute safety, because nothing in life is absolutely safe, but we can tell you that there are three options. Do not vaccinate your child at all (the highest risk); vaccinate with three separate vaccines (the next highest risk, because you are going to leave your children exposed for several weeks while they wait for the second and third jabs); and have the combined jab (lowest risk). I think this is a more sophisticated way to talk about risk and uncertainty.
AA: In the case of MMR, there was a small minority of scientists with a genuine contrarian view. Are there more sinister situations where people manufacture evidence or put out dubious data? Does everybody in pressure groups and industry play fair?
JK: Not always. Sometimes there are genuine arguments over evidence, but other times groups will selectively quote evidence or quote from the grey literature—that is, unrefereed or informal reports. I think the Soil Association reviews often quote from the grey literature where it suits its case.
AA: It is often said the press has to give equal weight to contrary views, even when the balance of evidence may be far from equal, and that this makes everything more difficult by whipping up controversy.
JK: I think it is more an issue of villains and heroes than of providing equal weight to all sides. A good media story, like a good film or a good play, works best with villains and heroes, and it is often convenient to paint the plucky minority individual as the hero fighting against the might of the establishment. People like conspiracies too and I think you have to accept that is the way the world works.
AA: The FSA is seldom cast as the hero.
JK: I think there were occasions when we were actually the hero but ended up cast as the villain because we were part of government. For example, we found that chicken condemned as pet food had been recycled illicitly back into the food chain: people were essentially taking pet food and turning it into chicken nuggets. We were part of the enforcement operation that uncovered this. But the media then portrayed it as our fault for allowing it to happen in the first place.
AA: In the case of Sudan 1, the illegal dye found in foods, you ended up with the largest ever recall of food in British history. This time it was industry saying that you had gone too far.
JK: It was a very interesting one. Sudan 1 probably has little risk, but the risks are uncertain and it was illegal. A lot of people in the industry thought we had overreacted when we insisted that it be taken out of the food chain. I imagined two scenarios. First, accept the risk is tiny and do nothing. Or second, say out loud that the dye is illegal and may carry a risk of causing cancer, and tell the food industry to act fast. To me, the second was the only acceptable course of action.
The real surprise was that the dye turned out to be so widespread in the food chain. We thought it would be found in a couple of dozen products, but it turned out to be almost 600, all because one company had made a Worcester sauce which was widely used by other companies. There is a lesson for the food industry. The legislation places the onus on the industry to check the integrity of its ingredients, and tests that detect substances like Sudan 1 are very cheap. It is not up to the FSA or local authorities. Our job is to make sure the industry does its job.
AA: Over the last two years, the agency seems to have been making a transition from "food safety" to "good health." The most visible campaigns have involved Sid the Slug, a cartoon character trying to persuade us to eat less salt. The agency has also stepped into the obesity debate. Can the state really stop Britons being fat and unhealthy?
JK: Food safety is clear; people want to know that beef is not going to give them CJD. But most people think that diet is a matter of individual choice. So government must tread carefully. The least invasive thing government can do is to provide information; the next is to ensure that the industry provides clear signposts, which might mean labelling in the case of food; and the most stringent of all is to regulate or ban certain foods. The industry view was that government's role should be just to inform and educate. They were keen to work with us on that. But we wanted to encourage the industry to accept the idea of better signposts or labelling on food, and to get them to recognise that the composition of the processed food they sell does have a significant effect on people's health. But we were not keen to introduce new regulations.
Salt was our first and easiest target. I went to the industry and told them that we had a scientific report coming up which would show that the evidence which links salt to blood pressure and to cardiovascular disease was growing ever stronger. It would say that people should not be eating more than 6g of salt a day—much less than the average 9.5g we eat now. The industry replied that it had never heard of consumers being worried about salt, and it was not on its agenda. But the fact is that 75 per cent of the salt you eat is the "hidden salt" added for you by the food industry, whether in pork pies, snacks or bread. We set out to persuade the industry to set itself targets, rather than to embark on a campaign of public humiliation. The first phase of the Sid the Slug campaign did catch the public's attention, and sales of domestic table salt showed a 10 per cent drop. The campaign is continuing, and the challenge for the future is to sustain it in a way that embeds salt in the psyche as a health risk, like smoking.
Signposts are also important, and the agency's new chair, Deirdre Hutton, has begun consulting on a traffic light-style food labelling scheme that should tell you at a glance whether a food is high, medium or low in salt, total fat, saturated fat and sugar.
Salt is a relatively easy challenge. If you ask why there is so much salt in microwave shepherd's pie, the answer, if you get the food industry on an honest day, is that it is the cheapest form of flavouring. Salt is not needed for product safety, except in things like cured meats. Moreover, several manufacturers said that when they took salt out of, say, tinned soup people actually liked the less salty variety, saying they could taste the tomato. So one success has been that salt levels have come down in some tinned soups.
Tackling obesity is different. It involves looking at all diet and physical activity as well. There are some things you can say for sure. Most of our weekly exercise comes from the routine things, so even if you play squash twice a week, it is only going to represent a small proportion of your weekly calorific expenditure. More exercise has to come in people's day-to-day lives—walking to the bus, cycling to work, using the stairs instead of the escalator. But if you are overweight it is much easier to lose weight by dieting than by taking exercise. You have to run for 45 minutes just to burn off a bar of chocolate.
AA: If foods like chocolate are partly to blame for the rapidly rising levels of childhood obesity, why not get tough and ban advertising of junk foods to children and stop junk foods being sold in schools?
JK: Well the industry claims that advertising only affects brand loyalty—whether you buy a KitKat or a Mars bar, not whether you buy chocolate or fruit.
AA: The cigarette companies used to say the same.
JK: We commissioned a review to try to discover whether television advertising affects children's diets. Every study on the issue is open to criticism, but the bulk of evidence suggests that there is an effect on children's diets. There is also a problem of defining junk food; it is not as obvious as you think. If you stress calories, for example, then olive oil, which lots of people think is good for them, becomes junk food. We set up a group to produce a scientific rationale for the whole nutrient profile of a food. Through this ladder of educating and informing, and then through clear labelling, we are making a start. We have to work through those before we leap to bans.
AA: In a hyperdemocratic age, will experts sink in a sea of conflicting voices where each opinion is equal?
JK: Experts will continue to play a central role. Scientific knowledge is distinct from other kinds of expert knowledge in being both cumulative and open to test. It should and will continue to be central in underpinning policy. The challenge in an age of hyperdemocracy is to blend expert advice (with all the limitations of uncertainty) into participatory decision-making. This includes equipping lay people with the ability to handle expert advice: if citizens are to fully exercise their democratic rights, basic science is as much a life skill as opening a bank account. That does not mean everybody should become a scientist, but rather that people should understand that science is not a set of ineluctable facts but a way of finding things out. People need to know how to deal with information, what to do when different kinds of evidence are quoted, examine where and how evidence comes from, and not to react with shock and horror when there are disagreements.
Life may have been simpler in the past when the authority of the expert was automatically respected. The zeitgeist is now much more questioning. So it is harder for people to know what to do in a time of many conflicting voices. If you knew whom you could trust, or whether you could trust anyone, that would help. Creating trust between experts and the public is not that different, in my view, from creating trust in any other kind of relationship. A lot of it is about building a track record, not claiming you have a complete answer when you don't, and making sure that you are telling it straight. In the past, experts often made the mistake of overclaiming for their knowledge. The future must be different.
