Have it Your Way

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I was arguing recently on a medical blog about the issue of laws mandating that caloric and nutrient information be conspicuously placed on menus at fast-food restaurants. New York state has legislators that want to ban added salt and high-fructose corn syrup at all restaurants.

One response, from another MD, was: “I don’t view putting nutritional information on the menu as forcing my preferences on others. Rather I view doing so as giving the consumer informed consent before consuming the food.”

Well, as it happens, working at McDonald’s was my first job. So I thought about the implications:

Customer: “I’d like a Big Mac, please.”

McDonald’s employee: “Sure. But first let me discuss with you the risks, benefits, and alternatives available to you. Big Macs contain two all-beef patties, cheese, lettuce, onions, pickles, special sauce on a sesame seed bun.

“The all-beef patties together weigh 3.2 oz. prior to cooking. We cook them on a 1,500 ° grill. There is a small but significant risk of E. coli infection. We have not personally seen this complication, but other restaurants have. There have been reported cases of younger children choking on sesame seeds. Please report choking to the proper authorities immediately. The American cheese slice is processed and chemicals are added to preserve freshness. There is a theoretical risk that some of these preservatives are carcinogenic in large doses, and therefore Big Macs ® are not recommended over the long term. The special sauce is proprietary, but you should be aware of the rare but life-threatening possibility of anaphylactic reaction to the sauce.

“Again, if pruritus, rash, tongue swelling, difficulty breathing, or feelings of faintness occur, dial 911. Do not call us or your physician.”

Customer: “So what’s the risk of E. coli infection?”

McDonald’s employee: “Over 12 billion sold. Four cases of E. coli infection.”

Customer: “Seems like a pretty safe bet. Big Mac, please.”

McDonald’s employee: “Now, you have a right to know there are alternatives to a Big Mac. In this same store you could instead have a Quarter Pounder or Angus Burger. Similar sandwiches are available nearby at Wendy’s, Burger King, In-and-Out Burger, and Jack-in-the-Box. If you wish, I can provide you with directions to these locations. Your choice of other restaurants will not affect the quality of my service when you order here.

”Customer: “I think I’ll just go with the Big Mac.”

McDonald’s employee: “Would you like fries with that? The fries are cooked in a hot vat of pure vegetable oil and salted. Excess salt intake may cause . . . .”

Customer: “No. Just the Big Mac.”

McDonald’s employee: “Yes sir. That will be $8.95 plus tax.”

Customer: “Prices have gone up, I see.”

McDonald’s employee: “I’m sorry, sir, but the training costs and time requirements of informed consent are not free. But you must admit you’re much better off now.”

It seems that even intelligent folks like doctors sometimes have difficulty grasping basic economics, such as the idea that mandates have costs, and that businesses already have every incentive to provide consumers with all the information they

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