Pret fallout

While the ongoing focus on food allergy resulting from the inquest into Natasha Ednan-Laperouse’s death has been good, other aspects of the tragedy have been somewhat overshadowed by the condemnation showered, rightly, on Pret a Manger for failing to ingredients-label that fatal baguette.

Apart from what appeared to be a somewhat jobsworth approach of the cabin staff on the flight who failed to even locate, let alone activate, the on board defibrillator, there is the whole question of the length of the needles in the Epipens which failed to work on Natasha.

A lengthy comment on my earlier blog from Susie Walker points to the previous previous deaths of three young girls (Poppy Harvey, Sahida Shahid and Natalie Giorgio) who had been injected multiple times with standard Epipens with a needle length of 16mm. While 15-16mm is long enough to reach the thigh muscle in a man,  it seems to be increasingly clear that it may not be long enough to reach the thigh muscle in a girl, even a slim girl, whose thigh structure is entirely different. A longer needle (such a the Emerade 24mm needle) may be needed. Susie suggests that to continue to market auto injectors to women with needles too short to guaranteeably reach their thigh muscles is just as irresponsible as Pret selling a baguette which includes sesame seeds without labelling it as doing so.

In a further comment on the same blog Hazel Gowland outlines the MHRA research she has been involved in since 2014, looking at needle length, at the most efficacious place on the thigh into which to inject and whether position at the moment of injection (standing, sitting, lying) makes a difference. It is excellent that this research is being done but they do not expect the results through until the end of 2019 – five years after the research was initiated. Which means that no change to the ‘guidance’ will be made before 2020 and no doubt further time will be given to implement a change assuming that they decide a change needs to be made.

Precautionary principle

Yes, changes in guidance and good practice should be research based but…. In this case:

• There appears to be good anecdotal evidence that 15-16mm needles may be too short to deliver life-saving adrenaline to girls and women suffering anaphylactic shock
• Increasing the length of the delivery needle for auto injectors prescribed for women by 10mm would appear to have no harmful side effects.
• Delivering sufficient adrenaline to the person in shock can save a life which may otherwise be lost.

Would the precautionary principle not suggest that, pending the results of the MHRA research, the length of the needles on auto injectors prescribed for woman should all be increased by 10mm anyhow – just in case that the research proves this to be  necessary measure?

The law of unintended consequences

It is, of course, good that as a result of all the publicity, so many more people have become aware of the seriousness food allergy and the challenges that food allergic people face when trying to eat away from home.

It is also good that Pret and no doubt other similar operators may now include ingredients on their ‘food to go’ items making it much easier for allergic customers to identify both safe and ‘dangerous’ foods.

But…

Look at the issue from the producer’s, and especially the food service producer’s point of view. With the honourable exception of the few dedicated freefrom-ers who enter and win gongs in the FreeFrom Eating Out Awards, the vast majority of the food service industry is still very nervous about ‘freefrom’. They see it as great marketing opportunity but they are not really quite sure what is involved and what they might need to do. And even a brief investigation into the subject will have shown them that food allergy and intolerance is a pretty complicated subject – which it is!

And now they see the opprobrium that has been heaped on Pret as a result of failing to be sufficiently allergy aware and sensitive, albeit that they kept within the law. OK, Pret will no doubt survive as it has very deep pockets and meets a large enough need in the general population. None the less, according to City AM in the immediate aftermath of the inquest hearing going public, Pret’s ‘impression score’ (whether someone has a positive or negative impression a brand) halved from 18 to 9 points. Pret may survive this, but could a smaller operator?

And that is quite apart from the horrendous possibility that, as a result of some relatively minor slip or failure on your part, someone could actually die as a result of eating your food. In fact, thank goodness, the actual number of deaths from food allergy remains extremely small (while 11 people in a million across Europe each year are at risk of being murdered only 3.5 are at risk of dying of anaphylaxis – see this study). But that is not how the risk is perceived and it is the perception that matters.

So how many food service operators who had been toying with the idea of offering ‘freefrom’ items on their menus may now just decide to play safe and not bother? And how many more may take the other route to ‘staying safe’ and just plaster their menus with ‘precautionary warnings’ that they cannot guarantee that any of their food will be truly safe for someone with an allergy?

It is not that difficult to run  ‘freefrom’ kitchen and to offer safe, allergen free foods – but it does take effort, attention – indeed dedication. There will always be some who will make that effort but also many who won’t.

So the sad consequence of the very welcome publicity that Natasha Ednan-Laperouse’s death has stirred up may be a reduction in the number of safe places that food allergic people to eat out – whereas we would have hoped for quite the opposite.