American Council on Science & Health (ACSH) [Printer-friendly version] June 25, 2002 PRECAUTIONARY PRINCIPLE RAISES BLOOD PRESSURE [Rachel's introduction: Henry I. Miller is one of the most flamboyant opponents of the precautionary principle. He is a professor at Stanford University who rarely lets mere facts stand in the way of a good yarn about the dangers of foresight and forecaring.] By Henry I. Miller, M.D. It used to be said that the most fearsome statement in the world is, "I'm from the government and I'm here to help you." Now, government officials have the "precautionary principle," which supposedly will make our lives safer. In fact, the principle -- which is not really a principle at all but a seemingly plausible excuse for opposing innovation -- has already laid waste to several industries and boasts a body count in the millions. The Environmental Protection Agency has just provided another egregious example: a crackdown on the most reliable kind of blood pressure cuffs -- which I and other doctors consider to be the standard for accuracy -- in order to cut down on the use of mercury, which can pollute the air and water if disposed of carelessly. The basic idea of the precautionary principle, which the EPA and other regulatory agencies often employ senselessly, is that even if there is no scientific evidence of actual dangers of a product, technology or activity, merely conjectural concerns should be a reason to limit or prohibit it. For example, although used for decades, I have never heard of a mercury spill from a broken blood pressure cuff. In any event mercury toxicity under these conditions would be modest. The EPA's action is ill-considered, myopic and dangerous: Inaccurate blood pressure measurements can lead to under- or over-medication of a person with a life-threatening disease. The precautionary principle is sometimes represented as being like Mom's admonition "better safe than sorry," or is said to reflect regulators' remonstrations that they're just "erring on the side of safety." But the way the precautionary principle is typically applied can actually increase risk. The principle focuses on the possibility that technologies could pose unique or unmanageable risks, even after considerable testing has already been conducted. Missing from precautionary calculus is an acknowledgment that even when technologies introduce risks, most confer net benefits -- that is, their use reduces many other, more serious hazards. The danger in the precautionary principle is that it distracts from known threats to health. For example, in eighteenth- century Europe, excessive precautionary bias delayed for decades the introduction of the first smallpox vaccine, while millions died unnecessarily. And thirty years ago, on the basis only of suspicion of toxicity to fish and migrating birds (but no evidence of harm to humans), the EPA drastically restricted production and use of DDT, an inexpensive and stunningly effective pesticide once widely used to kill mosquitoes and other disease-carrying insects. With the ensuing reduction of global DDT use, the World Health Organization estimates that 300 million to 500 million cases of malaria occur annually and more than one million people die. (See our article "DDT and Chemophobia" and ACSH's press release and report on the DDT ban.) Another horrendous example of the precautionary principle in action occurred in the late 1980s, when environmental activists, claiming that carcinogenic byproducts from the chlorination of drinking water posed a potential cancer risk, persuaded Peruvian officials to stop chlorinating much of their country's drinking water. That decision contributed to the acceleration and spread of Latin America's 1991-96 cholera epidemic, which afflicted more than 1.3 million people. Anti-chlorine campaigners recently have focused their attacks on certain plastics used for important medical devices, particularly fluid containers, blood bags, tubing and gloves; children's toys such as teething rings; and household and industrial items including flooring. Invoking the precautionary principle, activists claim that these plastics might have numerous adverse health effects -- even in the face of significant scientific evidence to the contrary. Whole industries have been terrorized, consumers denied product choices, and doctors and their patients deprived of lifesaving tools. The precautionary principle inflates the cost of research, inhibits new product development, wastes resources, restricts consumer choice, creates serious new risks, and costs lives. Just thinking about it raises my blood pressure. Henry I. Miller, a physician, is a fellow at the Hoover Institution and a Director of the American Council on Science and Health. He was an official at the U.S. Food and Drug Administration from 1979 to 1994.