Running away from safety

Remember Jim Fixx? Not many people do, and that’s a shame. Fixx was a jogging guru who ran 60 miles a week. He popularized the sport of running, and his “The Complete Book of Running” became a best seller. Thanks to him, millions of Americans now run to keep in shape. But almost 20 years ago this summer, 52-year-old Jim Fixx died of a heart attack … while running.

The tragic irony of Fixx’s death would be compounded, however, if we failed to learn an important lesson from it: Even actions that have risks can make us safer.

We often like to view risk as a binary problem: That is, something is either safe or it’s not. Unfortunately, the world just doesn’t work that way. Even something as simple as getting out of bed in the morning can increase our stress level, making us more susceptible to illness. Showering exposes us to the risk of slipping in the tub. Then, of course, there’s jogging. Our risk of having a heart attack increases while we run, but on balance, jogging makes us healthier.

Every choice is laden with risk. But so are the alternatives. After all, if we don’t get out of bed in the morning, we risk losing our jobs. The moral of the story is that nothing is safe, but some choices, such as jogging regularly, can make our lives “safer.”

On some level, we all have internalized this lesson. It’s what lets us get into a car and drive to work — the benefit is greater than the risk. But when we look to governments to regulate risk, we too often expect the outcomes to be black or white. That, however, can lead us, not in the direction of greater safety, but toward greater danger.

Consider a few examples.

Most people have heard a glass or two of red wine every day can reduce the risk of cardiovascular disease. But few know that the same is true for any kind of alcoholic beverage, or that moderate consumption also reduces the risk of stroke and lowers overall mortality. Why don’t more people know this? In part, it’s because the federal government has long prevented beverage manufacturers from saying anything about it.

The ostensible reason for the marketing restriction is that advertising any positive association between alcohol and health could mislead consumers and cause a wave of excess consumption, even though that is well known to have detrimental health effects. Consequently, an ad strategy that could improve overall public health is forbidden because neo-prohibitionists refuse to believe individuals can be trusted to differentiate between moderation and excess.

The same kind of thinking permeates the regulation of tobacco advertising. Cigarette smoking is well known to raise the risk of illnesses such as lung cancer, emphysema and heart disease. But despite anti-smoking campaigns, laws that make it illegal to smoke in many public places, and the surgeon general’s warning on every box, about 25 percent of American adults still smoke cigarettes and about half of them are so hooked on nicotine they find it too difficult to quit.

This has opened a booming market in smoking cessation products, and you would think cigarette manufacturers would try to cash in by producing less hazardous forms of tobacco. They have — high-tech cigarettes that deliver the desired nicotine, but little or none of the smoke that is really harmful, for example, along with other “smokeless” tobacco products. But there’s one major obstacle standing in their way: anti-tobacco zealots who see “safer” products as a distraction from their goal of eliminating tobacco use altogether.

After the relationship between cigarettes and lung cancer became clear in the 1950s, tobacco companies responded by introducing filter-tipped brands with less tar and nicotine. In a shortsighted decision, however, the Federal Trade Commission forbade use of comparative health claims in cigarette advertising, stalling the competition to make tobacco less lethal.

Still, scientific bodies, such as the American Medical Association and the National Cancer Institute, encouraged further research into tobacco products that, while not safe, were less hazardous. But by the 1980s, any talk of “safer” tobacco became completely taboo. Even “smokeless tobacco” products, which don’t cause respiratory disease or lung cancer and are estimated to carry a mere 2 percent of the health risk posed by cigarette smoking, can only note differences in the level of certain elements related to risk. They may not, however, be advertised as “less hazardous” than cigarettes, even though it is demonstrably true.

Clive Bates, director of Britain’s Action on Smoking and Health, says, “There is a convincing argument that smokeless tobacco can substitute for cigarettes and help people to quit smoking — and do them much less harm. … We have to do more than simply offer the alternative of ‘quit or die.’ ”

Mr. Bates and many other public health experts think a switch from cigarette smoking to smokeless tobacco could save tens of thousands of lives every year, and the makers of smokeless tobacco products have recently petitioned the Federal Trade Commission and lobbied Congress for permission to say so. No good deed goes unpunished, though.

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