A System of Ethics for Food

1
A System of Ethics for Food?

• The Precautionary Principle
• Cedric Garland, Dr.P.H., F.A.C.E.
• Adjunct Professor, Family and Preventive
  Medicine, UCSD
• October 15, 2003 430 PM

2
Objectives

• To be able to explain the Precautionary
  Principle.
• Describe its application to food.
• Describe data showing a link between maternal
  consumption of cured meat with brain tumors in
  their children
• Describe the Random misclassification favors the
  null axiom

3
Objectives

• To define a system of ethics
• To explain the rationale for a system of ethics
• To specify the advantages and limitations of a
  particular system of ethics
• To set criteria for a new system of ethics
• Propose a system of ethics for a field which has
  none or only a vague sense of propriety.

4
The Precautionary Principle

• Where there are threats of serious or
  irreversible damage, lack of full scientific
  certainty shall not be used as a reason for
  postponing cost-effective measures to prevent
  environmental degradation. U.N. Conference on
  Environment and Development, Principle 15
  (www.cid.harvard.edu/)

5
Gastric Cancer Enigma

• 185 mg/kg of nitrite was found in Frankfurters
  in 1923 (some as high as 1400 ppm)
• In 1923 USDA limited nitrite to 200 mg/kg, and
  maximum concentration dropped by 2/3, to about 60
  mg/kg in 1937
• Nitrosamines are formed by nitrite in cured
  meats, and are extremely potent gastric
  carcinogens

6
Gastric Cancer Enigma

• Gastric cancer death rates were increasing in the
  1920 in the U.S. It was then the most common
  cause of cancer death.
• After 1930 they started to decline precipitously
  , and are still declining
• In many countries when nitrite intake is high,
  such as Japan and Germany, gastric cancer rates
  remain extremely high.
• (Paik et al. Int J Epidemiol 2001)

7
Cured meat and brain tumors

• 540 cases of brain tumors, aged 0-19 yr
• 801 frequency-matched controls (age, area, birth
  year)
• Odds ratio was 2.3 for average intake of 0.5-1.0
  mg/day (95 CI 1.3-4.4).
• Random misclassification biases to null principle
  (True O.R. probably much higher than 2.3)

8
Cured meat and brain tumors

• There is 1 mg of nitrite in a hot dog
• The high-risk mothers were consuming the
  equivalent to one-half to one hot dog per day, a
  smal amount
• (Pogoda JM and Preston-Martin S. Public Health
  Nutrition 2001)

9
Example of an Ethical System

• The Hippocratic Oath (Geneva Version, 1948 rev.
  1968)

10
Oath

• I solemnly pledge myself to consecrate my life to
  the service of humanity
• I will give to my teachers the respect and
  gratitude which is their due
• I will practice my profession with conscience and
  dignity
• The health of my patient will be my first
  consideration

11
Oath - II

• I will respect the secrets which are confided in
  me . . .
• I will maintain, by all the means in my power,
  the honor and the noble traditions of the medical
  profession
• My colleagues will be my brothers

12
Oath - III

• I will not permit considerations of religion,
  nationality, race, politics or social standing to
  intervene between my duty and my patient

13
Oath - IV

• I will maintain the utmost respect for human life
  from the time of conception even under threat, I
  will not use my medical knowledge contrary to the
  laws of humanity.

14
Advantages of ethical system

• Universal guidelines are provided, despite
  national and cultural differences in laws and
  mores.
• Adherence will enhance reputation.
• Adherence enhances solidarity and peer support
  (colleagues are brothers)

15
Advantages - II

• Adherence
• Confers prestige (consecration of life to the
  service of humanity is a respected aim)
• Avoids loss of community trust by limiting
  release of confidential information.
• May reduce the threat of litigation.

16
Advantages - III

• Provides that worthy teachers of medicine will be
  compensated for their efforts, or at least
  appreciated. (After all, teachers are the
  principal disseminators of the system.)

17
New provisions?

• There is no provision regarding reasonableness of
  fees, or exhortation against charging patients or
  government for services not performed.
• Proposed addition
• I will not accept a fee for a service not
  performed, or substantially overcharge, whatever
  the source of payment.

18
New - II

• There is no provision regarding advertising in
  mass media, which may induce patients to choose
  physicians based on criteria other than
  experience, diminishes prestige, and is costly.
• Proposed addition
• I will not advertise my practice in mass media.

19
New - III

• There is no provision regarding acceptance of
  valuable inducements by representatives of
  pharmaceutical manufacturers seeking
  prescriptions.
• Proposed addition
•  I will not accept inducements from the
  pharmaceutical industry intended to influence my
  choice of medicines

20
New - IV

• There is no explicit guidance regarding
  acceptance of profits from sales of prescriptions
  or referrals.
•   Proposed addition
• I will not engage for profit in the sale of
  medicines, or accept payment for prescribing
  medicines or referring patients.

21
New - V

• Oath does not explicitly include the most
  enshrined and, arguably, the single most valued
  guideline in medicine and public health, First,
  Do No Harm.
• Proposed addition
• I will remember to First, do no harm.

22
Questions

• Would a Hippocratic Oath for food be
  worthwhile?
• What are the criteria for developing such an
  oath?
• What would be the elements be?
• What benefits would it provide?
• What harm might it engender?