Marler Blog - Providing commentary on food poisoning outbreaks & litigation

It is long past time for meaningful changes in the safety of the food our children eat.  Whether the food is raw, local, organic, small farm, big farm, mass-produced or slow, if it contains E. coli O157:H7, or another pathogen, it can kill.  It can kill your child, grandchild or the child of a friend.  It can kill just like it killed Abby.  Here is her story:

 It is time to step up and make Abby and her family the last to suffer this horror.  Mr. President, Senators, Congress Members, do your jobs!

Abby’s illness, and her Grandfather's, were linked to a Class I Recall by FSIS in May 2009 - Illinois Firm Recalls Ground Beef Products Due To Possible E. coli O157:H7 Contamination

Lawsuit Seeks to Cover Millions In Medical Expenses

Victims of an August, 2008 outbreak of E. coli O111 have joined together to file suit against the Country Cottage restaurant, where they were sickened. The lawsuit was filed today in the District Court in the State of Oklahoma, in and for the County of Mayes, on behalf of twelve families.

“Many of us regularly entrust restaurants with our health and safety,” said the families’ attorney, William Marler. “There are stringent rules and regulations that restaurants must follow, because any deviation from those rules can cause illnesses. Sadly, this outbreak shows how very wrong things can go, and how much suffering can result.”

The outbreak at the Country Cottage Restaurant in Locust Grove, Oklahoma sickened 341 people, hospitalized 70, and caused the death of one man. Investigators quickly pinpointed the restaurant as the source of infection, but were unable to determine the specific vehicle. E. coli is often contracted by consuming food or beverage that has been contaminated by animal (especially cattle) manure. E. coli outbreaks have been tied to meat, produce, unpasteurized milk, cheese, and cider, sprouts, juice, and even water. The lawsuit cites the restaurant’s use of water from an unpermitted, on-site well just before the outbreak—in violation of Department of Environmental Quality (DEQ) regulations – as a basis for punitive damages.

“These fourteen people collectively spent 250 days in the hospital, 84 of them on dialysis for kidney failure,” continued Marler. “Their medical bills are almost two million dollars, not to mention ongoing medical care that many will continue to need. Our job is to make sure that they don’t struggle to carry that immense burden by themselves.”

Parke Wilde keeps the U.S. Food Policy blog. He teaches graduate level courses in food policy and statistics at the Friedman School of Nutrition Science and Policy at Tufts University. In this list, he looked beyond the excellent sites that already appeared in a recent list at Culinate, which included Ethicurean, Green Fork, ChewsWise, Food Politics, Politics of the Plate, Grist, Civil Eats, and Obama Foodorama. Parke's list adds some more blogs from within what might loosely be called the "good food movement," but it emphasizes other selections that he reads to maintain diversity in his information stream.

10 Excellent Food Policy Blogs - Marler Blog - Commentary on food poising outbreaks and litigation.

On September 25, 2009, I posted Part 1 of a 4-part series that examines the food safety record of both pasteurized and raw dairy products. Below is Part 2, which provides background on the occurrence of foodborne pathogens in milk products, and mechanisms of contamination.

Occurrence of Foodborne Pathogens in Milk and the Dairy Environment

Dairy animals such as cattle and goats may carry foodborne pathogens (e.g., Campylobacter, E. coli O157:H7, Listeria monocytogenes, Salmonella; see “cons” for a more extensive list). Often cows and goats that harbor foodborne pathogens in their gastrointestinal tracts do not appear to be ill. Occasionally, some of these bacteria cause mastitis (infection and inflammation of the udder), and may be shed directly into the milk. Certain strains of Salmonella and Listeria monocytogenes can cause serious systemic illness in ruminants. For example, Salmonella Dublin is a strain that is host adapted to cattle, and can lead to severe diarrhea and death in both cattle (especially calves) and humans.

Several authors have conducted extensive surveys of foodborne pathogens in bulk tank raw milk (BTM) and the dairy environment (Hancock et al 1998; Jayarao et al, 2006; LeJeune et al, 2009; Oliver et al, 2005; Oliver et al, 2005; Shere et al, 1998). BTM is milk from multiple cows mixed and stored in a container. Modern conventional dairies usually ship their milk in tanker trucks off-site for pasteurization. Milk from multiple farms may be mixed together. The majority of milk produced for pasteurization comes from confined animal feeding operations (CAFOs). In contrast, most commercial raw milk produced for human consumption in the US comes from pasture-based management systems as promoted by the Weston A. Price Foundation (WAPF). Milk from multiple cows may be mixed together and stored in a container, but raw milk from multiple farms is not usually combined. An exception would be “outsourcing” where the dairyman purchases additional milk from surrounding dairies to meet supply needs. This practice is probably uncommon, but considered dangerous because outsourced milk is not produced as required for the Grade A raw milk designation.

The most recent review of the literature on foodborne pathogens in BTM was published by Oliver et al (2009). The range in prevalence for BTM was summarized as follows:

Campylobacter: 2 – 9.2%
E. coli O157:H7: 0 - 0.75%
Listeria monocytogenes: 2.8 - 7.0%
Salmonella spp: 0 – 11%
Shiga-toxin E. coli: 2.4 - 3.96%
Yersinia enterocolitica: 1.2 – 6.1%

WAPF has raised a valid concern about using these surveys when assessing the occurrence of foodborne pathogens in commercial raw milk (e.g., raw milk sold legally on- or off-farm in the US). Because the BTM tested in these surveys was likely destined for pasteurization, the data does not specifically address the microbial quality or pathogen prevalence in Grade A raw milk sold for human consumption. Additional research is needed that compares BTM samples from licensed raw milk dairies to BTM intended for pasteurization. Furthermore, to fully understand the risk of pathogen contamination in raw milk being purchased and consumed in the US, surveys are needed that examine the prevalence of foodborne pathogens in raw milk produced by licensed, inspected raw dairies; unlicensed, “black market” raw dairies; and raw dairies selling their products as “pet food.”

Raw Bovine Colostrum

Colostrum is the “first milk” produced by the mammary gland of an animal after giving birth. Consumption of raw bovine colostrum appears to be increasing in popularity among raw milk drinkers, and has been associated with two recent foodborne disease outbreaks in California (CDC 2008; CDPH 2008). Unlike raw milk, raw bovine colostrum is regulated as a nutritional supplement. A recent survey of dairies in Pennsylvania by Houser et al (2008) found Salmonella in 15% of the colostrum samples; the mean standard plate counts (SPC) and coliforms were very high: 977,539 CFU/ml and 323,372 CFU/ml, respectively (see Oliver et al, 2009, for a broader discussion of sanitation standards). It was not specified in the paper if these dairies surveyed in Pennsylvania sold raw bovine colostrum for human consumption. Additional surveys are needed to study foodborne pathogens and sanitary standards in raw bovine colostrum from dairies that market the product as a nutritional supplement for humans.

Addressing the WAPF Claim: “Clean Grass Fed Cows” are Safe

WAPF and their Chapter members strongly promote the idea to their customers that raw milk is safe if produced by “clean grass fed cows.” Yet, the organization does not provide any survey data to support these claims. The only studies that potentially relate are found in the literature on grass vs. grain feeding and prevalence of E. coli O157:H7. This topic was reviewed previously. Briefly, the scientific evidence at this time does not support a broad conclusion that grass feeding significantly and consistently reduces the risk of E. coli O157:H7 or other dangerous foodborne pathogens from entering the food chain. More importantly, none of the surveys or experiments that WAPF cites examined raw milk operations, and instead focused primarily on dietary effects for cattle in feedlot conditions.

Most of the data on foodborne pathogen occurrence in the raw milk dairy environment comes from outbreak investigation reports. There are several examples where foodborne pathogens were found in the milk, cattle feces, and/or milking barn at dairies that follow WAPF principles including pasture-based, grass only feeding. In 2005, Washington state investigated an outbreak of E. coli O157:H7 linked to a cow-share, and found the outbreak strain in raw milk and environmental samples at the dairy (CDC 2007). In 2006, retail raw milk and colostrum were implicated in an outbreak of E. coli O157:H7 among children in California (CDC 2008). The outbreak strain was not found on the farm, but E. coli O157:H7 was present in the herd. In 2007, Campylobacter jejuni was isolated from 35% of fecal samples from cows at that same dairy in California; the outbreak strain was found in 4 fecal samples from those cows (CDPH 2008).

Addressing the WAPF Claim: Raw Milk Kills Pathogens

Another unsubstantiated claim by WAPF relates to the idea that raw milk is safe because the “good” bacteria and specific components in the unheated milk will destroy pathogens. A comprehensive review of this topic is beyond the scope of this paper. Briefly, the evidence that WAPF uses to promote this claim comes primarily from a paper by Doyle and Roman (1982) where Campylobacter jejuni was found to die-off at a more rapid rate in raw milk compared with sterile milk. However, the number of C. jejuni organisms in raw milk did not drop to a level below the infectious dose until about 7 days after inoculation. Furthermore, most C. jejuni stains also died-off in sterile milk, but not until a couple days later. WAPF does not make this distinction when promoting the safety of raw milk. Another consideration not addressed adequately by WAPF in their claims about raw milk safety is the importance of temperature abuse. Both raw and pasteurized milk are rich in nutrients, and if stored above refrigeration temperatures, can serve as an excellent medium for growth of pathogens (Wang et al, 1997).

A more extensive discussion on competitive exclusion and consumer perceptions was recently published by Rose (2009) as a White Paper.

How is Milk Contaminated with Pathogens?

There are 3 important points to consider about how milk becomes contaminated:

1. The initial mechanisms for raw milk contamination with pathogens are the same whether the milk is destined to be consumed raw, or pasteurized:

• Mastitis and shedding of the pathogen directly from the cow’s udder into the milk
• Entry of manure or dirt into the milk during the milking process
• Transfer of pathogens by vectors if they come in contact with the raw milk (for example, flies may carry pathogens on their legs and mouthparts)
• Human carriers transferring pathogens from their hands to the milk

2. The major difference between raw and pasteurized milk is the fact that the heat treatment during pasteurization destroys pathogens that may have entered the raw milk as described above.

3. Both raw and pasteurized milk can be contaminated during bottling, shipment, and storage. Pasteurization only destroys the pathogens in the milk at the time of processing; if unsanitary conditions allow pathogens to re-enter the milk later, it will be contaminated again.

There are two general causes of contamination of pasteurized milk:

1. Equipment failure: The pasteurization equipment fails and there is raw milk in the product sold as pasteurized. This can happen if the temperature is not high enough, or if the milk is not heated long enough. For example, in 1984, an outbreak of Salmonella Typhimurium occurred in a convent in western Kentucky (CDC, 1984). There were 16 illnesses and one patient developed a Guillain-Barre-type illness. The convent had a steam pasteurizer and investigators believe that the temperature may not have been high enough and/or the holding time was too short. The convent had no time-temperature gauge to record and monitor the process.

2. Post-pasteurization contamination: the milk is contaminated after pasteurization, usually through unsanitary handling of the milk. An example of post-pasteurization contamination involving a multi-drug resistant strain of Salmonella Typhimurium occurred in Pennsylvania and New Jersey in 2000 (Olsen et al, 2004). There were 93 illnesses and at least 6 hospitalizations. No Salmonella was isolated from the milk, but investigators concluded that the milk was most likely contaminated after pasteurization due to unsanitary conditions at the processing plant. For example, high humidity and excessive condensation in the plant could have produced droplets carrying Salmonella that fell into open containers of the pasteurized milk.

In the Age of Bioterrorism

Intentional contamination of the food supply through a bioterror attack has become an increasing concern. Wein and Liu published a provocative paper in 2005, where they modeled the vulnerability of pasteurized milk though the farm-to-consumer supply chain using botulinum toxin. They considered milk a possible target because of its symbolic value in society. The authors concluded that due to the rapid distribution and consumption of milk, an attack could result in several hundred thousand individuals poisoned with botulinum toxin.

It is worth noting that the conventional pasteurized milk supply is far more vulnerable to a massive poisoning compared with today’s raw milk supply. Several enormous, natural foodborne disease outbreaks involving pasteurized dairy products illustrate this point (Ryan et al, 1987; Hennessy et al, 1996). However, recent petitions to FDA to expand the raw milk supply chain by lifting the interstate ban on shipment could potentially increase the vulnerability of raw milk to larger outbreaks because a single contaminated lot would be consumed by many more individuals across a wider geographic area.

“Good” vs. “Bad” Bacteria: Probiotics and Dairy Products

One of the major concerns expressed by WAPF and other raw milk advocacy groups is that heat treatment by pasteurization destroys “good bacteria,” as well as pathogens. An example of “good” bacteria would be probiotics. A simple definition of a probiotic is a live microorganism (such as Bifidobacteria and Lactobacilli) that is beneficial to health when consumed. An example of a benefit from probiotics would be improved digestion.

Although raw milk may contain “good bacteria,” it is debatable whether raw dairy products fit the scientific definition of a probiotic food (see my previous review on Raw Milk Pros). Animals do not excrete “good bacteria” in their milk (usually milk is sterile when it exits the mammary gland). Both “good” and “bad” bacteria enter milk by the same mechanisms as described above. Sanitation during milking and processing at a raw milk dairy to prevent pathogens from entering the milk will very likely also lower the levels of probiotic bacteria. The ultimate question for the consumer is whether the trade off is worth the risk. It is worth noting that there is very little research on this topic. For example, studies are needed to measure the species and concentration of “good” bacteria in commercial raw dairy products to determine if they are sufficient to confer a probiotic effect.

In recent years, pasteurized dairy products containing probiotic bacteria have become increasingly popular. Products such as Activia® and DanActive® contain specific species and numbers of live probiotic microorganisms that are added to the dairy product after pasteurization to kill harmful bacteria.

The next segment of this review will compare foodborne illnesses and disease outbreaks linked to raw and pasteurized dairy products.

References

Blogs With Bite, by Mike Licht - Blogs with Bite is an occasional omnivorous sampling of food blogs and sites we find particularly tasty. Follow the trail of bread crumbs back to earlier editions, starting here:

Food Safety News — Comprehensive “daily Web-based newspaper … reporting on issues surrounding food safety.” Presented by Marler Clark LLP, PS, a law firm “dedicated to representing victims of food poisoning.”

Mr. Cox of the Farm-to-Legal Defense Fund (FTCLDF) informed me (through several emails that he says are just from him, not on behalf of FTCLDF - although he is General Counsel for FTCLDF) that I was mistaken and I agree with him. 

I assumed that the farmer in a 2008 raw goat milk E. coli O157:H7 outbreak that nearly killed two children, who claimed that he consulted with FTCLDF, had also consulted with FTCLDF about disclosing communications between the farmer and the FTCLDF.  According to Mr. Cox, FTCLDF did not at all work on this case and did not have an attorney client relationship with the farmer.  I accept that from Mr. Cox. 

I expect to see the documents the Court ordered disclosed that the farmer - not FTCLDF - tried not to disclose in the next few days.  Here is the recent Court Order:

But, on to more important issues:

Comparing the Food Safety Record of Pasteurized and Raw Milk Products – Part 1

“Milk and milk products—particularly those that are unpasteurized—are potentially hazardous; even pasteurized products have been implicated in outbreaks. Contamination may occur after pasteurization, and no process works perfectly 100% of the time.” John M. Leedom

A week or so ago I posted, "Raw Milk Debate Set to Heat Up." 

Over the last years I have tried to bring some level of rationality to the debate over the consumption of raw milk. I first published on my blog a summary of the findings of my review of peer-reviewed literature on the topic of the "pros" of the consumption of raw milk. Several people from both sides of the raw milk debate have told me that the “pros” review is one of the most comprehensive compilations of peer-reviewed literature examining the potential benefits of raw milk beyond basic nutrition. I then posted about the "cons." What about the “cons?” As I said, the overwhelming “con” of drinking raw milk according to the literature relates to food safety hazards.

Since publishing these reviews last year, many readers have asked how the safety of pasteurized milk compares with raw (unpasteurized) milk. The Weston A. Price Foundation (WAPF) went so far as to produce an extensive, highly repetitive, 132 page response to my paper, "Raw Milk Cons: Review of the Peer-Reviewed Literature." WAPF claims that there is a systematic bias against raw milk. In reality, pasteurized milk-related outbreak reports were not analyzed in the raw milk cons review. In response to the erroneous statements by WAPF, and in an effort to provide consumers with accurate information, I examined the food safety record of both pasteurized and raw dairy products.

This 4-part series begins with an overview of the history and definitions that are important to know in order to understand how dairy food safety became a lightening rod for controversy.

Historical Perspective

Early last century milk products caused approximately 1 out of every 4 outbreaks due to food or water in the United States (Weisbecker 2007). As we begin the 21st century in this country, dairy products cause the fewest outbreaks of all the major food categories (e.g, beef, eggs, poultry, produce, seafood) (CSPI 2008). This drastic improvement in the safety of milk over the last 100 years is believed to be due primarily to pasteurization, and improved sanitation and temperature control during the processing, handling, shipping and storage of fresh milk products.

In 1948, Michigan was the first state in the US to require pasteurization. In 1987, the FDA mandated pasteurization of all milk and milk products for human consumption effectively banning the shipment of raw milk in interstate commerce with the exception of cheese made from raw milk, provided the cheese has been aged a minimum of 60 days and is clearly labeled as unpasteurized. A recent survey conducted by state agriculture departments found that 29 states currently allow some form of on- or off-farm raw milk sales, but only 13 permit retail sales (Oliver et al, 2009).

Definitions: Milk is Milk?

A typical dairy case at a major grocery store today contains numerous choices for the customer. There is milk labeled with different levels of fat content, and where retail raw milk sales are allowed, the consumer may choose between conventional, organic, and raw milk products, as well as homogenized or non-homogenized. In addition to fluid milk, other dairy products include butter, cheese, cream, ice cream, colostrum, yogurt, kefir, and other fermented dairy products.

Below are some basic definitions of raw and pasteurized milk.

Raw (unpasteurized): for disease surveillance purposes, “raw” or “unpasteurized” refers to a dairy product that has received no heat treatment to destroy pathogens or spoilage organisms. WAPF promotes a more refined definition for raw milk, termed “real milk,” that also includes organic, non-homogenized, “grass fed,” and produced from certain breeds of cattle as criteria.

Pasteurized: Pasteurization was named after Louis Pasteur, who discovered the process for the preservation of wine. When talking about milk, pasteurization refers to the heating of milk or milk products to a certain temperature for a specific period of time. The purpose of pasteurization is to destroy disease causing and spoilage organisms. The Grade A Pasteurized Milk Ordinance allows for different combinations of time and temperature:

• High Temperature Short Time (HTST): uses metal plates and hot water to raise milk temperatures to at least 161° F for not less than 15 seconds following by rapid cooling

• High Heat Short Time (HHST): similar to HTST, but uses slightly different equipment and higher temperatures for a shorter time

• Ultra Pasteurized (UP): milk is heated to not less than 280° F for two seconds

• Ultra High Temperature (UHT): milk is heated until sterile

Among these methods, only UHT milk is sterile (shelf stable), and does not require refrigeration. The other methods of pasteurization do not destroy all organisms, thus milk whether raw or pasteurized eventually spoils, and must be refrigerated to prevent the growth of pathogens.

Homogenization: Homogenization is a process that breaks the fat globules in milk into smaller particles, which prevents the cream layer from separating and floating to the top of the milk. Most conventional pasteurized milk is homogenized whereas organic pasteurized milk and raw milk are often non-homogenized.

The Debate

The controversy over banning raw milk sales has raged since pasteurization was first introduced over 100 years ago. Throughout decades of debate, the public health and medical communities have remained steadfast in their support of pasteurization as a key measure to protect the public health. In the 1980’s, a fierce legal battle was fought in California, which culminated in the closure of the largest raw milk dairy in the nation at the time and a Citizen’s Petition that successfully banned interstate shipment of raw milk. Today, the Campaign for Real Milk created by WAPF is currently among the most vocal of the groups that promote consumption of raw dairy products and eschew pasteurization.

WAPF has made bold claims that raw milk produced by “clean grass fed cows” is safer than any other food. Public health officials have made similarly bold claims that raw milk is an inherently dangerous food. In the next segment of this review, the mechanisms by which milk can become contaminated, and the occurrence of food borne pathogens in the dairy environment, are described.

References

CSPI. 2008. Outbreak Alert! 2008: Closing the gaps in our Federal food safety net. Available at: http://www.cspinet.org/new/pdf/outbreak_alert_2008_report_final.pdf

Leedom, J. M. 2006. Milk of nonhuman origin and infectious diseases in humans. Clin Infect Dis 43:610-5.

Oliver, S. P., K. J. Boor, S. C. Murphy, and S. E. Murinda. 2009. Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis 6:793-806.

Weisbecker, A. 2007. A legal history of raw milk in the United States. J Environ Health 69.

Eric first called out Marion Nestle’s famous site – Food Politics. He then gave Food Safety News the following tip o’ the pen:

The second site – Foodsafetynews.com – is a new effort by lawyer and food safety expert, Bill Marler. At first glance, it would be easy to dismiss Marler because he specializes in food safety litigation, and has represented hundreds of cases for people injured because of food poisoning and related matters. Obviously, he’s making money on this, but take another look. Unlike many attorneys who have found food litigation to be a virtual hot water tap for revenue, Marler uses his position to fight for food safety, and researches and writes extensively on the matter. He knows his stuff and has testified before Congress and various state legislatures, as well as addressed numerous organizations about food safety issues. Did I say he’s blunt? A recent blog entry was titled “BBC reports that Godstone Farm animals test positive for E. coli - No S**t!” but without those family-friendly little asterisks. Marler’s a bulldog.

While he and his staff have written and blogged extensively about food safety, his new site is more consumer oriented and easy to navigate. I’m eager to see what happens with it.

From the GAO:

Over the past few years, several food recalls, such as for beef and peanut products, have affected schools. It is especially important that recalls affecting schools be carried out efficiently and effectively because young children have a higher risk of complications from food-borne illnesses. GAO was asked to determine how federal agencies (1) notified states and schools about food recalls, (2) advised states and schools about disposal and reimbursement of recalled food, and (3) ensured that recalls were being carried out effectively. To do this, GAO reviewed and analyzed relevant documents and interviewed federal and state officials, as well as officials from 23 school districts that had experience with at least one of four recent cases involving the safety of food in the school lunch program.

Despite its efforts, the U.S. Department of Agriculture's (USDA) Food and Nutrition Service (FNS), which oversees federal school meals programs, did not always ensure that states and schools received timely and complete notification about suspect food products provided to schools through the federal commodity program. The federal commodity program provides food to schools at no cost to the schools, and accounts for 15 to 20 percent of food served in school meals. During 3 recent recalls, FNS notified states, but in only one case did it inform schools to hold and not serve suspect foods prior to an official recall of commodity products. When a videotape aired by the media showed inhumane treatment of cattle at a plant that provided beef to the commodity program, FNS told states to have schools stop serving the company's beef weeks before the official recall of commodity beef was announced. However, when the U.S. Department of Health and Human Services' (HHS) Food and Drug Administration (FDA) recalled suspect peanut products and canned vegetables in two other cases, FNS did not inform states and schools to hold and not serve the companies' commodity products until the recalls were expanded to include the companies' commodity products--weeks later. FNS's initial notification to states regarding recalls did not provide complete information on the full range of products affected. Instead, states and schools continued to receive information on multiple other recalled products over time. It sometimes took states and schools a week or more to determine what additional products were subject to a recall, during which time they unknowingly served affected products. FNS provided instructions for disposal and reimbursement of recalled products to states who, in turn, provided instructions to schools but, nonetheless, some schools experienced problems. Some schools reported to GAO problems in finding landfills that would accept large quantities of recalled products. Some schools also reported that reimbursement instructions were not clear, reimbursement was delayed for months, and that all of their expenses related to the recalls were not reimbursed. Although both USDA's Food Safety Inspection Service (FSIS) and the FDA procedures direct them to conduct recall quality checks, neither included thousands of schools that had received recalled USDA-commodities products for the beef and peanut recalls because they thought FNS conducted these checks. As a result, they were unable to ensure that the recalls were being carried out effectively by schools. FNS officials said that they did not conduct any kind of systematic quality checks of schools receiving recalled commodities, because they relied on FSIS and FDA to conduct such checks. FDA did include schools in its canned vegetable recall audit checks, and some may have received recalled-commodity canned vegetables. However, because FDA does not systematically sample for schools or analyze results of the quality checks for the group, the agency cannot be assured that the recall was carried out effectively in schools.

Experts from the Veterinary Laboratories Agency (VLA) said 33 of 102 samples were likely to contain the O157:H7 strain of the infection. This included samples from Lambs, pigs, goats, cattle, ponies and rabbit droppings at a Surrey farm at the centre of an E. coli outbreak. During its visit to Godstone Farm scientists found two samples of E. coli O157 on the floor of the main barn. Nigel Gibbens, Defra chief Veterinary officer, said: "Joint HPA and VLA investigations have confirmed the presence of E. coli O157:H7 bacteria in faeces from a wide range of animals on a premises in Surrey.

The Health Protection Agency (HPA) said the total number of E. coli cases linked to Godstone Farm had risen to 67. Eight children remain in hospital in a "stable or improving condition".

Let’s see, there is a long history of animal to human bacterial contamination in both England and the United States – see www.fair-safety.com. Here are a few that we have litigated – and continue to do so:

Lane, Oregon - County Fair E. coli O157:H7 Litigation - Marler Clark represented many of the 82 people, most of them young children, who were sickened by E. coli O157:H7 at the Lane County Fair in Eugene, Oregon, in the summer of 2002.

North Carolina State Fair E. coli O157:H7 Outbreak Litigation - The North Carolina State Department of Health and Human Services (DHHS) announced on November 8 that the North Carolina State Fair was the source of over 106 cases of E. coli O157:H7 amongst persons who attended the fair. On December 16, N.C. DHHS released an outbreak report, and stated that “Many activities in the Crossroads Farm Petting Zoo were associated with illness.”

AgVenture Farms E. coli O157:H7 Outbreak Litigation - The Florida State Department of Health (DOH) identified 22 confirmed cases of E. coli O157:H7 and Hemolytic Uremic Syndrome in Central Florida during March, 2005. At least 35 additional cases were suspected as of April 1, 2005.

What I find most bothersome is that each time it happens in either England or the United States, health officials and petting zoo owners seem to pretend it is happening for the very first time.  Here is a PowerPoint I presented in 2004 - we seem never to learn.

My 10 year old daughter's soccer team, the "butt kickers," lost 5 to 0 today.  Still was fun to watch.

Spending most of the week in DC gave me a chance to promote and get feedback on the now six day old online publication - www.foodsafetynews.com.  So far, so good.  Not only are we able to highlight some of the best sources of Food Safety information on the web - like Bites and Barfblog - but we will be adding in several more "foodie feeds."  Most exciting is that we are adding two more reporters to the mix and are receiving numerous requests for guest contributors.

Click on image to download PowerPoint:

I must admit I like Washington DC.  Every time I get here I seem to pack much in, because there is always so much to do.  I had a full day today and will be on the Hill all Friday pitching food safety.

I started out the morning with a presentation to the American Insurance Association.   I presented to them ways to get food manufacturers to pay more attention to the details of safe food production.  My pitch was that if food manufacturers took care of their customers (stopped poisoning them), insurance companies would spend a lot less money on my clients.

I then had meetings with the folks at Pew Food and Consumer Product Safety and the Center for Science in the Public Interest Food Team.  Both are doing good work to protect consumers.

I even had time to get stuck in traffic because the street near my hotel was blocked due to the White House Farmers Market.

Also, www.foodsafetynews.com gets a few more mentions.  Tom Karst, over at the Packer, wrote today - "Bill Marler is everywhere (again)."

Food safety attorney Bill Marler has created another level to his omnipresence. Check out this Web site called Food Safety News. The site seems to be well-staffed – I met one FSN.com reporter at the United Fresh WPPC event. I’m not sure what the revenue model is…perhaps this is what Bill will do after a perfected food production system “puts him out of business.”

A little over a year ago, I hosted a fund-raiser for Cy’s run for Manhattan District Attorney.   It was a bit of the “who’s who” of the Seattle legal community – primarily white-collar criminal types (that being the lawyers for those criminals). It was what you would expect from a Cy event – a suite at one of the oldest and finest hotels with a commanding view of the city where Cy made a name for himself far away from being the son of Cyrus Vance Sr.

Seldom shy at these types of events (I tend to be the “one stop shop” for Democratic candidates who find themselves low on funds in Seattle), I offered to say a few words in support of Cy and his candidacy. I decided to tell the story about how Cy and I almost first crossed paths. The story goes like this:

In 1988 after nearly a year of being a lawyer, I was casting about for another place to hang my shingle (why is another much longer story). One of the premier firms of trial lawyers in the city was the firm, Culp, Dwyer, Guterson and Grader (a few years later Dwyer became a well-respected Federal Judge and Guterson’s son, David, wrote a best seller, “Snow Falling on Cedars”).

So, I sent in my resume. Within a week I got a call for an interview, and then another, and then lunch with several associates, and then a meeting with several partners, and then a dinner with a few more and my new girlfriend (now my long-suffering wife of 21 years). I thought I had the job nailed.

I waited for the offer.

Finally, after a few days I got a call from one of the partners who I had met with several times. He said, “Bill, I have good news and bad news.” I asked for the bad. “Bill, we are not offering you the job.” I asked for the good. “At least we are offering the job to Cyrus Vance Jr., as I am sure you understand.”

Well, I want to thank Cy for being at the right place at the right time. Had Cy not been there to take that job, I might have actually been hired. And, if hired there, I would not have been at the firm where I eventually secured the Jack-in-the-Box E. coli case in 1993. And, well, the rest is history.

I am happy to raise money for Cy and I wish him all the very best.

Professor Donna M. Byrne of William Mitchell College of Law gave us a “shout out” about Food Safety News today:

Kudos to Marler Clark for launching a promising and informative new website. Food Safety News is a news site rather than a blog (Bill Marler's MarlerBlog is still going strong too). The site has reporters who are not lawyers, as well as contributed articles by lawyers and others. I've added it to my favorites bar - I like it that much.

Dan Mitchell of Slate’s “Daily Bread” wrote this morning "Lawyers Launch Food Safety News Site:"

Marler Clark, perhaps the best-known law firm involved in food-safety litigation, has launched a news site that the firm describes as "a daily Web-based newspaper dedicated to reporting on issues surrounding food safety."

Bill Marler, the firm's managing partner, will continue writing his opinionated MarlerBlog, in addition to contributing to the new site, called Food Safety News.

In a Q&A on the site, Marler said that until now, there was no "up-to-date one-stop place for food safety information." He's also "been disappointed to see reporters on the food, health, and product safety beats lose their jobs to the fall of print journalism and the rise of consolidated media."

Despite Marler's standing as a fierce critic of (and lawsuit filer against) the food industry, he promises the site will offer "balanced reporting" as well as commentary.

The site's editor, Dan Flynn, has worked both in public relations and journalism. He is working from Denver, while other staffers work out of Washington, D.C., and Seattle, where Marler Clark is based.

The site is well-designed, clean, and user-friendly—all relatively rare, especially among news sites. In addition to news of outbreaks of foodborne illnesses and product recalls, there are sections for policy and law, litigation, and international food-safety news.

Dan Mitchell has written for The New York Times, Chicago Tribune, Minneapolis Star-Tribune, and Wired.

On the third anniversary of the Dole Spinach E. coli outbreak, once again Lynne Terry of The Oregonian and Bill Keene super, senior epidemiologist, break yet another food poisoning story. This time, according to Ms. Terry, “[f]ederal and state health authorities are investigating a salmonella outbreak that peaked in Oregon in August.”

According to Dr. Keene, “[a]t least 124 were sickened across the country, with a clustering of cases in the West. In Oregon, seven people became sick between Aug. 4 to 16, including three in the Portland metro area. Two people got so sick they had to be hospitalized, and one had severe symptoms [a Marler Clark Client], Keene said.”

Scientists from the Centers for Disease Control and Prevention and the Food and Drug Administration still do not know exactly what poisoned people, though shredded lettuce is a leading suspect, Keene said.

Question - where did lettuce come from?

Interestingly, Tanimura & Antle, Inc. of Salinas, California expanded the geographic scope of its voluntary recall of bulk and wrapped romaine head lettuce last week due to positive Salmonella tests.  The company extended the U.S. recall to all 50 states. The recall also included Puerto Rico and Canada.  Originally, the recall was issued after a random test conducted by the Wisconsin Department of Agriculture tested positive for Salmonella.  At the time of the recall no illnesses had been linked to the finding.  Romaine lettuce included in the recall was harvested June 25 - July 2. Shelf life of the product typically is 14 n 16 days.  At this point it is unclear if Tanimura & Antle is the source of this outbreak reported by Ms. Terry.

Or, perhaps it is not lettuce?

Muranaka Farm Inc. recalled 1,005 cases of parsley distributed in 10 states because it may be contaminated with Salmonella.

Frontera Produce of Edinburg, Texas recalled one lot of cilantro due to Salmonella.  The recalled cilantro was available at select store chains in Texas, Oklahoma, Colorado, Louisiana and New Mexico.

And, what the hell is wrong with leafy greens?  Some examples:

August 1993 - E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State

July 1995 - Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana
September 1995 - Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho

September 1995 - Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine

October 1995 - Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio

May-June 1996 - Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York

May 1998 - Salad E. coli O157:H7; two reported cases in California

February.-March 1999 - Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska

July-August 2002 - Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho

October 2003 - thirteen residents of a California retirement home were sickened, and two people died, after eating E. coli-contaminated, pre-washed spinach

October 2003-May 2004 - Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California

April 2004 - Spinach E. coli O157:H7; 16 reported cases in California

September 2005 - Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

November-December 2006 - Taco Bell and Taco Johns E. coli shredded lettuce sickened hundreds in Mid-west and East

We are a bit excited that this has now gone live.  Love to hear your comments.  Click on image to access site:

Muranaka Farm Inc. is recalling 1,005 cases of parsley distributed in 10 states, including Illinois, because it may be contaminated with salmonella.

The Moorpark, Calif., company says it's voluntarily recalling cases of 60-count fresh bunched parsley, lot code 0023909, after sampling conducted in cooperation with the Food and Drug Administration showed bacteria.

Thirty cases of the parsley were distributed in Arizona; 574 were distributed in California; 35 in Colorado; 60 in Florida; three in Iowa; one in Illinois; seven in Missouri; five in Tennessee; 278 in Texas; and 12 in Wisconsin.

Had a great chat with Evan Kleiman of KCRW Radio a few weeks ago.  I am about 8:22 into the podcast - click below:

It is not live yet, but by Monday we should have all the "bugs" worked out.  Our goal here is to have a place were "all the news fit to eat" can be found along with all the best information about recalls, new technology and politics.  We will have contributors from government, industry, universities and consumer groups.  A lively discussion will be had.  The link is www.foodsafetynews.com.

My 10-year-old daughter, Sydney and I were almost packed for the Conference at the end of the month when it was canceled due to the 60th Anniversary of the revolution.  We are looking forward to attending the Conference on its new dates on November 4 and 5.  I am going to also speak at a few law schools.  Sydney is going to attend elementary school for a day - between visiting the Great Wall, etc.  I urge all to attend.  This says it all:

"The Chinese government attaches great importance to food safety because it is not only in the interest of the Chinese but also people in the world," Premier Wen Jiabao, People's Republic of China

I just learned that AQSIQ Minister Wang Yong has called for CIFSQ to be postponed until after the 60th anniversary of the Revolution Celebration (first week of October) is completed.  The Conference is now likely to be set in late October or early November.

What strikes me about this, is the power of the Government.  Hopefully that same Government continues its "great leap forward" on Food Safety.

Secretaries Sebelius and Vilsack at National Food Policy Conference in DC today announced a redesigned www.foodsafety.gov.  However nice it looks, is our food any safer?  Follow live tweets from conference @foodsafetynews and @obamafoodorama and @AgLawLLM

Here is another perspective on non-O157:H7 that seems to indicate that they cause illness, but less severe illness that E. coli O157:H7.  That being said, it is also quite likely that the severe illnesses related to non-O157:H7 are under counted due to a lack of surveillance.  This presentation also did not take into account the Oklahoma E. coli O111 outbreak that sickened over 300, dozens with severe Hemolytic Uremic Syndrome and one death.  Perhaps we could focus on, test for and list as adulterants, the top 6 reported non-O157 STEC in the US (all of these have been associated with HUS according to the CDC) - O26, O111, O103, O121, O45, and O145?

Non-O157 shiga toxin-producing Escherichia coli (STEC) are the causative agents of zoonotic emerging infectious diseases, often of bovine origin. Below is a general review of non-O157 STEC prevalence studies in humans, cattle, and beef products.

Humans

Non-O157 STEC infections are under-recognized and under-reported due to inadequate epidemiological and laboratory surveillance. In the United States, E. coli O157:H7 became nationally notifiable in 1994, whereas non-O157 STEC infections were not reportable until 2000, following adoption of a position statement (2000 ID#1) by the Council for State and Territorial Epidemiologists (CSTE). At that time, the CSTE recognized that the threat to public health from STEC infections extended beyond just the E. coli O157:H7 serogroup.

In recent years, improved diagnostic assays for non-O157 STEC have contributed to an increased appreciation of the severity of disease caused by these strains including hemolytic uremic syndrome (HUS). Notably, the number of non-O157 STEC cases reported to CDC’s FoodNet has risen steadily each year; from 2000-2006, there was an overall 4-fold increase in incidence (0.12 cases per 100,000 to 0.42 cases per 100,000 population) at FoodNet sites. The most common serogroups reported to cause foodborne illness in the United States are O26, O111, O103, O121, O45, and O145 (Brooks et al, 2005).

Johnson et al (2006) evaluated the emerging clinical importance of non-O157 STEC and concluded that these strains may account for up to 20 to 50% of all STEC infections in the United States. Clearly, the prevalence of non-O157 STEC infections is placing an enormous burden on society and the health care system in the United States.

Cattle as Reservoirs

Beef and dairy cattle are known reservoirs of E. coli O157:H7 and non-O157 STEC strains (Hussein, 2007; Hussein and Sakuma, 2005). In reviews of STEC occurrence in cattle worldwide, the prevalence of non-O157 STECs ranged from 4.6 to 55.9% in feedlot cattle, 4.7 to 44.8% in grazing cattle, and 0.4 to 74% in dairy cattle feces. The prevalence in beef cattle going to slaughter ranged from 2.1 to 70.1%. While most dairy cattle-associated foodborne disease outbreaks are linked to milk products, dairy cattle still represent a potential source of contamination of beef products when they are sent to slaughter at the end of their useful production life (termed “cull” or “spent” dairy cows); this “dairy beef” is often ground and sold as hamburger.

The high prevalence of non-O157 STEC in some cattle populations, combined with the lack of effective on-farm control strategies to reduce carriage, represents a significant risk of contamination of the food supply and the environment.

Beef Products

Numerous non-O157 STEC serotypes known to cause human illness are from bovine origin, thus putting the beef supply at-risk. Both E. coli O157:H7 and non-O157 STEC may colonize the gastrointestinal tract of cattle, and potentially contaminate beef carcasses during processing. Although not as well studied, the risk factors for contamination of beef products from cattle colonized with non-O157 STECs are probably the same or very similar to E. coli O157:H7. For example, cattle hides contaminated with E. coli O157:H7 during slaughter and processing are a known risk factor for subsequent E. coli O157:H7 contamination of beef products. One study showed that the prevalence of non-O157 STEC (56.6%) on hides is nearly as high as that found for E. coli O157:H7 (60.6%) (Barkocy-Gallagher et al, 2003).

Hussein and Bollinger (2005) evaluated published reports from over three decades and found that non-O157 STEC were more prevalent in beef products compared with E. coli O157. In their study, the prevalence of non-O157 STEC ranged from 1.7 to 58% in packing plants, from 3 to 62.5% in supermarkets, and an average of 3% in fast food restaurants. In a recent survey of retail ground beef products in the United States, 23 (1.9%) of 1,216 samples were contaminated with non-O157 STEC (Samadpour et al, 2009). In another study, researchers found a 10 to 30% prevalence of non-O157 STEC in imported and domestic boneless beef trim used for ground beef (Bosilevac et al, 2007).

Non-E. coli O157:H7 Outbreaks

Worldwide, non-O157 STEC outbreaks emerged in the 1980’s, and the first reported outbreaks in the United States occurred in the 1990’s (Hussein 2007; Brooks et al, 2005). The number of reported outbreaks due to non-O157 STECs remains relatively low in the United States, but experts agree that documented outbreaks probably represent the “tip of the iceberg.” From 1983-2002, seven non-O157 STEC outbreaks were reported in the United States (Brooks et al, 2005). During the following five-year period from 2003-2007, CDC documented an additional five non-O157 STEC outbreaks (CDC Outbreak Surveillance Data, http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm).

Products Implicated in Previous Outbreaks

There is a paucity of information on the vehicles of transmission for human non-O157 STEC infections, but contaminated raw dairy products, produce, and water have been implicated in the United States (Brooks et al, 2005). A review of non-O157 STEC in Connecticut showed that exposures, including ground beef, were similar in both non-O157 STEC and E. coli O157:H7 cases, suggesting that the routes of transmission are similar (CDC 2007). Considering the relatively high prevalence of both E. coli O157:H7 and non-O157 STEC in cattle populations and their products, it is not surprising that ground beef and other beef products could be a common food vehicle.

Non-O157 STEC outbreaks attributed to ground beef and its sausage products have been documented outside the United States including Argentina, Australia, Germany, and Italy. These beef-related outbreaks involved 8 STEC serogroups (O1, O2, O15, O25, O75, O86, O111, and O160). HUS cases were reported in five of the six outbreaks, mostly striking children and the elderly.

More rigorous investigation into the cause of non-O157 STEC outbreaks is needed to better understand the role of beef products and other foods in the contamination of the human food supply with these strains. Bettelheim (2007) described non-O157 STECs as “under-rated pathogens.” Indeed, the surveillance trends suggest that if left unchecked, it is only a matter of time before the United States experiences large non-O157-related outbreaks. Amending FMIA regulations to include pathogenic non-O157 STEC strains under the definition of “adulterated” is an urgently needed step in the prevention and control of these potentially deadly pathogens.

References

Barkocy-Gallagher, G. A., T. M. Arthur, M. Rivera-Betancourt, X. Nou, S. D. Shackelford, T. L. Wheeler, and M. Koohmaraie. 2003. Seasonal prevalence of Shiga toxin-producing Escherichia coli, including O157:H7 and non-O157:H7 serotypes, and Salmonella in commercial beef processing plants. J Food Prot. 66:1978-86.

Bettelheim, K. A. 2007. The non-O157 shiga-toxigenic (verocytotoxigenic) Escherichia coli: under-rated pathogens. Crit Rev Microbiol. 33:67-97.

Bosilevac J. M., M. N. Guerini, D. M. Brichta-Harhay, T. M. Arthur, and M. Koohmaraie. 2007. Microbiological characterization of imported and domestic boneless beef trim used for ground beef. J Food Prot. 70:440-9.

Brooks, J. T., E. G. Sowers, J. G. Wells, K. D. Greene, P. M. Griffin, R. M. Hoekstra, and N. A. Strockbine. 2005. Non-O157 shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. J Infect Dis. 192:1422-9.

CDC. 2007. Laboratory-confirmed non-O157 shiga toxin-producing Escherichia coli – Connecticut, 2000-2005. MMWR. 56:29-31.

CDC. 2008. Shiga toxin-producing Escherichia coli: burden and trends. FoodNet News, Winter 2008. Available at: http://www.cdc.gov/FoodNet/news/2008/January_FoodNet_News.pdf

Hussein, H. S. and L. M. Bollinger. 2005. Prevalence of Shiga toxin-producing Escherichia coli in beef. Meat Sci. 71:676-89.

Hussein, H. S. 2007. Prevalence and pathogenicity of shiga toxin-producing Escherichia coli in beef cattle and their products. J Anim Sci. 85:E63-72.

Hussein, H. S. and T. Sakuma. 2005. Prevalence of shiga toxin-producing Escherichia coli in dairy cattle and their products. J Dairy Sci. 88:450-65.

Johnson, K. E., C. M. Thorpe, and C. L. Sears. 2006. The emerging clinical importance of non-O157 shiga toxin-producing Escherichia coli. Clin Infect Dis. 43:1587-95.

Samadpour, M., V. Beskhlebnaya, and W. Marler. 2009. Prevalence of non-O157 enterohaemmorrhagic Escherichia coli in retail ground beef in the United States. 7th International Symposium on Shiga Toxin (Verocytoxin)-producing Escherichia coli Infections. Buenos Aires, Argentina.

Recall Release CLASS I RECALL
FSIS-RC-046-2009 HEALTH RISK: HIGH

Big Boy Food Group, a Warren, Mich., establishment, is recalling approximately 39,514 pounds of ready-to-eat meal kits that may be contaminated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.  The following product is subject to recall:

Dinolunch Brand:

* 3.6 oz “DINOLUNCH CARNIVORE HAM & CHEESE” meal kits. Each tray includes ham, cheese, and crackers; a juice drink and Dino cookies. The front of each package bears the establishment number “EST. 4205” inside the USDA mark of inspection as well as the Use by/Sell by date of “10/24/2009.”
* 3.6 oz “DINOLUNCH T-REX TURKEY & CHEESE” meal kits. Each tray includes turkey, cheese, and crackers; a juice drink and Dino cookies. The front of each package bears the establishment number “P- 4205” inside the USDA mark of inspection as well as the Use by/Sell by date of “10/24/2009.”

Each case of the Dinolunch brand meal kits, subject to recall, can be identified by the case code “9237” and contains approximately twelve (12) trays. The products were produced on August 25, 2009 and distributed to wholesale and retail establishments in Texas.

Lunch Buddies Brand:

* 3.6 oz “Lunch Buddies Ham & Cheese” meal kits. Each tray includes ham, cheese, and crackers; a juice drink and a sweet treat. The front of each package bears the establishment number “EST. 4205” inside the USDA mark of inspection as well as the Use by/Sell by date of “10/24/2009.”
* 3.6 oz “Lunch Buddies Turkey & Cheese” meal kits. Each tray includes turkey, cheese, and crackers; a juice drink and a sweet treat. The front of each package bears the establishment number “P- 4205” inside the USDA mark of inspection as well as the Use by/Sell by date of “10/24/2009.”

Each case of the Lunch Buddies brand meal kits, subject to recall, can be identified by the case code “9237” and contains approximately sixteen (16) trays. The products were produced on August 25, 2009 and distributed to wholesale establishments in Ill., Ind., Ohio, and Wisc. FSIS has no reason to believe that these products are available for consumer purchase as recalled products were distributed only at the wholesale level; so, none of these meal kits would have reached consumers.

I am off to the Arkansas School of Law later this week to give a series of lectures on Food Safety and how the law can assist in making our food supply safer.  I am using a video from Jack-in-the-Box and a recent Raw Milk case to add to why it is "a bad idea to poison your customer."  Click on below to see my PowerPoint.  Between suing Dole, Nestle, JBS Swift and McDonalds in the last few weeks, I still have speeches to give in Washington DC and Beijing before the end of the month - cloning anyone?

We decided to create a "one stop shop" for everything food safety.  This will be the place to get "all the news that fit to eat" - and warnings what not to eat too.  There will be news and opinion feeds from Bites, Blogs (www.marlerblog.com) and Twitter.  There will be recall notices from industry and government.  We hope to have a complete listing of food safety jobs in industry and government as well as a calendar of upcoming conferences.  Of course, there will be more information on the bugs that harm us.  The site is not live yet, (www.foodsafetynews.com), but we have bureaus in Seattle, Denver and Washington D.C. operational with other contributors around the world.  Keep tuned in.

I sat in a mediation today in San Francisco until it became painfully obvious that Dole, Natural Selection Foods, Mission Organics and Pic-n-Save were unwilling to fairly compensate a Wisconsin woman who nearly died after eating E. coli O157:H7-tainted spinach in 2006.  She was hospitalized for months and incurred nearly $500,000 in medical bills.  Good news is that I get to sue them in the morning.  I am sure a good jury in Wisconsin will treat her much more fairly.

I had time to draft an Op-ed on the interconnectedness of the the health care debate and food safety.  If I do not get it published, I'll post it here in a few days.  I also had time to finish up my keynote speech at an upcoming food safety conference in Beijing China in a few weeks.  I think China can learn from our mistakes.  Click below to download the PowerPoint.  Click here to see video.

I would rather be here:

Doing this:

But, I am in an airport working on this (click to download):