As someone with a background in public policy making and enforcement, I find it alarming that so much public policy today, particularly in schools, is motivated by fear-of-lawsuit hysteria rather than sound research, cost-benefit analysis, least restrictive means to meet the policy objective and other rational criteria.
One extreme example of hysteria-based decision making is the banning of peanut products in schools. Two articles on Associated Content recently reported an increased incidence of United States schools considering banning peanut products in an effort to protect children allergic to peanuts (you can read them by clicking here and here.) Is this sound public policy or hysteria based over-regulation?
Statistics
There are 53.3 million school age children in the United States, according to the United States Census Bureau’s statistics for the year 2003.
Peanut allergies affect 1 percent of the United States population or 3 million people; for one in four of those, or 750,000, the allergy symptoms cause severe respiratory or gastro-intestinal symptoms. These numbers include persons of all ages from babies to adults.
20% of children with peanut allergies outgrow them by the time they reach school age and up to 50% outgrow them eventually.
Different researchers estimate the number of Americans who die each year from food-induced anaphylaxis from all allergy-inducing foods combined at 100-150. Some studies state that most of those who die are children, while others describe those most likely to die as adolescents and young adults. The most severe food-induced allergic reactions result from peanut or tree allergies.
There are 133,362 schools serving grades k-12 in the United States, according to the United States Department of Education.
Is it reasonable to restrict the activities of 53,300,000 school children in the hopes of preventing the death or serious health risk to any peanut allergy sufferers when:
the total number of annual deaths in all age groups is 100-150;
making the greatly exaggerated assumption that all the deaths would occur among school age children at school, the deaths would affect .0002 percent of the regulated population;
the total number of annual severe peanut allergy episodes among all age groups is 750,000;
again, making the greatly exaggerated assumption that all such severe episodes would occur among school children at school, the episodes would affect 14 percent of the regulated population;
however, a more realistic estimate might be one-sixth of that amount or 2.3 percent, since the school age population is roughly one-sixth of the total United States population; and,
there are less restrictive alternatives available to protect the target population without regulating the excess 52,550,000 – 53,300,850 people for whom the regulation is both unnecessary and a burden?
Remember that the incidents affecting preschoolers and babies and adults are included in the death and allergy episode statistics and that the food-induced anaphylaxis statistic includes other foods as well as peanuts. Banning peanut butter and other peanut products in schools will not reduce those incidents. Nor will it prevent incidents involving school age children that occur outside of school.
Motor vehicle deaths killed 7677 children ages 0-18 in 2003. This is 54 – 76 times the number of people that died from anaphylaxis. Should all children be banned from riding in motor vehicles? If banning peanut butter for 53,300,000 school children is reasonable to prevent some number less than 100-150 deaths, why don’t we save more than 54 – 76 times that number by banning all 73.7 million children in the United States from riding in cars? This is not a facetious question. Think about the policy implications of both bans.
Between 40 and 100 Americans die each year from anaphylaxis resulting from insect stings. This estimate is believed by experts to be underreported. Is it time to eradicate all of the stinging insects on the face of the Earth?
No one on either side of the peanut ban issue wants to see a child suffer severe allergy symptoms or die from anaphylaxis. The issue is not whether child peanut allergy sufferers’ interests require some sort of protection but whether a universal peanut ban is the right protection. To ban peanuts from schools imposes a huge burden on tens of millions of families. Besides not packing peanut butter, it means not allowing children access to foods cooked with peanut oils and foods prepared in places where peanuts have been processed. This requires scrutinizing the labels of all prepared foods the children bring to school and all foods used by the cafeteria. It means worrying about what nonallergic kids and even teachers ate before they arrived at school and whether their bodies and clothing have been scrupulously cleaned to prevent the import of peanut dust. In a word, a ban on peanut products in schools is unrealistic to the point of impossible, besides being bad public policy.
Less intrusive practices such as alternate eating arrangements for peanut allergic students, safe storage/ready access to epi pens (which can cause death if used on a child not suffering an allergy episode), along with ample food allergy education, need to be implemented.
Sources: Peanuts, Folic Acid and Peanut Allergies, http://www.marchofdimes.com/professionals/14332_1819.asp; Sampson HA. In Allergy, Principles and Practice, 5th Ed., E. Middleton et al, ed. Mosby, St. Louis, p. 1162. 1998; AAAAI Board of Directors. “Anaphylaxis in schools and other childcare settings.”; Journal of Allergy and Clinical Immunology 102 (2):173-6. 1998; http://www.childtrendsdatabank.org/indicators/53Numberofchildren.cfm; Peanut Allergy, http://www.allergicchild.com/peanut_allergy.htm; Peanut Allergy Plagues More and More Kids, but Half of Those Affected Will Likely Outgrow It,
http://12.31.13.50/healthtopics/allergies/Sep04acMain.htm; Allergy Statistics,http://medicineworld.org/medicine/allergy/allergy-statistics.html (citing Bock SA, Munoz-Furlong A, and Sampson, HA. Fatalities Due to Anaphylactic Reaction to Foods.” Journal of Allergy and Clinical Immunology 107: 191-193. 2001; Sicherer SH, Munoz-Furlong A, Burks AW et al.: Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. Journal of Allergy and Clinical Immunology 103:559-62, 1999); www.nationmaster.com.
