May 2010

The office is closed for Memorial Day, but I am here working on my speech (title above) to be given at the NEHA conference next week.  I am supposed to cover:

What’s behind the shiny abattoir walls of contemporary slaughterhouses? After all the regulation, safety protocols, worker initiatives, and animal rights action, we still have millions of pounds of beef recalled every year due to contamination with deadly pathogens like E. coli O157:H7 and its toxic cousins. Hundreds are sickened, many are permanently injured, and there are still deaths. Why can’t we get it right? Food safety attorney Bill Marler will address the many challenges facing the meat industry and the consumers who eat their product. In addition to the discouraging list of what isn’t working in the system, he will present a list of proactive steps that can be taken to improve the safety of the American meat supply.

And, I have only 50 minutes?  By the way, did you know that that in 1906 the US population was only 85,450,000 and today it hit 309,388,000.  Per capita beef consumption was 71.1 pounds in 1906, today about 60.0 pounds.  And, we had, and have, a black and white President:

The CDC estimates that "non-O157 STECs (like O26, O45, 0103, O111, O121, and O145) cause 36,700 illnesses, 1,100 hospitalizations and 30 deaths in America each year."

In speaking about the recent E. coli O145 outbreak linked to romaine lettuce, Patricia M. Griffin, chief of CDC’s Enteric Diseases Epidemiology branch, said it is likely that E. coli O145 has caused previous food poisonings but has gone undetected because only about 5 percent of clinical laboratories are able to detect it. "The fact that we found it now doesn’t mean it wasn’t there before," she said. "The ability to look for the organism in ill people and in outbreaks and food has been increasing. We’re gradually finding more of these organisms."

And, here is the memo to prove it (click image to download):

I love Economists.  Actually, one of my three BA’s was in Economics.  When you look at the cost of just two bugs that the Economic Research Service (ERS) looked at, you have to wonder why we do not demand more from the corporations who feed us and the government that is supposed to regulate them?

The Economic Research Service (ERS) estimates of the costs of illness and premature death for a number of foodborne illnesses have been used in regulatory cost-benefit and impact analyses. Like all cost estimates, the ERS estimates include assumptions about disease incidence, outcome severity, and the level of medical, productivity, and disutility costs. Changes to any of these assumptions could change the cost estimates and, as a result, change the way policymakers rank risks, prioritize spending, and formulate food safety policies.

The Foodborne Illness Cost Calculator provides information on the assumptions behind foodborne illness cost estimates—and gives you a chance to make your own assumptions and calculate your own cost estimates. Link here.  For information on the bugs they missed, visit www.foodborneillness.com.

With raw milk in the news nearly everyday, I thought supporting a website that offered unbiased facts on the pros and cons of consuming raw milk products would be useful in the raw milk debate. More than anything, I wanted to be able to have a place where parents could “find out the answers to commonly asked questions about raw (unpasteurized, unprocessed) milk benefits, safety, and how risks from raw milk compare with other foods like pasteurized milk, fresh fruits and vegetables, and meat/poultry/fish.”

I hope you find the site helpful – www.realrawmilkfacts.com.

U.S. Senator Kirsten Gillibrand last week introduced new legislation to require the U.S. Department of Agriculture (USDA) to regulate the six currently unregulated strains of E. coli proven to cause food-borne illnesses. In addition to the most common form of E. coli that is already regulated, the Centers for Disease Control and Prevention (CDC) has identified six rarer strains, known as non-O157 STECs. The CDC estimates that non-O157 STECs cause 36,700 illnesses, 1,100 hospitalizations and 30 deaths in America each year.

E. coli O157:H7 is by far the most common strain in American beef. But non-O157 STECs are increasingly found in beef imported from other countries, but is never checked for since current law only requires imported ground beef to be checked for E. coli O157:H7.

Senator Gillibrand’s new legislation adds the six confirmed strains to the list of adulterants, requires meat companies to test for and discard any batches containing any toxic strains of E. coli, and gives the USDA the authority to find and regulate more toxic strains in the future.

Specifically, Senator Gillibrand’s legislation:

* Amends the Federal Meat Inspection Act to revise the definition of the term ‘‘adulterated’’ to include contamination with E. coli.

* Defines E. coli as “enterohemorrhagic (EHEC) Shiga toxin-producing serotypes of Escherichia coli (E. coli).”

* Includes the following E. coli strains: O157:H7, O26, O45, 0103, O111, O121, O145

* EHEC was chosen because it is, by definition, pathogenic, meaning disease causing. This strikes a compromise between being overly-inclusive (not all STEC are pathogenic) and under-inclusive (not closing the door on as yet unidentified strains of pathogenic E. coli)

* By expanding the definition of adulterants to other strains, it will require USDA to begin spot testing procedures, force companies (through legal pressure) to test and eliminate the pathogen, and require FSIS to recommend best testing practices to companies.

There seems to be no middle ground in the debate over raw milk. On the one side, you have farmers happy to sell a product for $10 to $18 a gallon, and consumers who believe that they are purchasing a product that is not only more healthful but will also cure everything from allergies to autism. On the other side, you have public health officials defending the time-tested benefits of pasteurization as a way to make milk safe to consume.

But even though the argument appears to have two sides, the reality is as simple as it is undeniable: raw milk is seriously risky, and should be consumed, if at all, with extreme caution.

Health department officials in Minnesota this week have reported three, and possibly four, E. coli O157:H7 infections linked to drinking raw milk from a dairy in Gibbon. All of the sick were infected with a strain of bacteria that has the same “pulsed field gel electrophoresis” (PFGE) pattern, or DNA fingerprint. One infected child has now developed Hemolytic Uremic Syndrome (HUS), a potentially deadly complication.

Counting Minnesota, there have now been at least nine outbreaks of illness tied to raw milk since January 2010. The other states with outbreaks include Nevada, Utah (two outbreaks), New York, and Pennsylvania. There was also a multistate outbreak with illnesses confirmed in Michigan, Indiana, and Illinois. Washington has had two as well. And, even worse, these outbreaks involved at least three different pathogens: E. coli O157:H7; Salmonella, and Campylobacter. More specifically:

  • In January, a dairy farm in New York was linked to five Campylobacter infections.
  • Another outbreak of Campylobacter was reported in February in Pennsylvania. State health officials there said approximately ten people became ill after drinking raw milk. One of the ill developed Guillain – Barre Syndrome, became paralyzed, and is still hospitalized.
  • In March, raw milk caused at least seventeen Campylobacter infections in Michigan, Illinois, Indiana.
  • In April, Utah was the site of Salmonella and Campylobacter outbreaks tied to raw milk. The first cluster included nine reported cases of Campylobacter infection. The second cluster included six reported cases of Salmonella.
  • Earlier this month, Nevada health officials reported that a child became seriously ill with a Campylobacter infection after eating homemade raw milk cheese that was illegally sold door-to-door.
  • Washington has had two E. coli O157:H7 outbreaks both linked to the same dairy.

Over the last several 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 a review of peer-reviewed literature on the topic of the "pros" of the consumption of raw milk. Most alleged benefits were anecdotal, with a reduction in allergies as the only scientific observation. I then posted about the "cons." The overwhelming “con” of drinking raw milk, according to the scientific literature, relates to the serious risk of infection, and the injury, disability, and death that result.

In trying to base the debate over the pros and cons of raw milk more firmly on facts, and not anecdote and emotion, I have found that the most instructive thing that I can do is to remind debate-participants of “real world” effects that drinking raw milk can cause. For example:

Chris Martin, then age seven, developed an E. coli O157:H7 infection in September 2006 following consumption of raw milk. He was hospitalized beginning September, suffering from severe gastrointestinal symptoms. Shortly thereafter, he developed hemolytic uremic syndrome (HUS). In an effort to properly treat his rapidly deteriorating condition, Chris was moved to multiple medical facilities, twice by life-flight. His HUS was remarkably severe, marked by prolonged renal failure, pancreatitis, and severe cardiac involvement. He required 18 days of renal replacement therapy. On two occasions his cardiac problems became so severe that he was placed on a ventilator. At several junctures, the possibility that he might not survive was very real. Ultimately he was hospitalized through November, after incurring over $550,000 in medical bills. Renal experts have opined that Chris is likely to develop severe renal complications in the future. These complications include end stage renal disease (ESRD) and kidney transplant.

Mari Tardiff was one of those sickened in the June 2008 outbreak of Campylobacter connected to raw milk. As a result of her campylobacter infection, Mari developed Guillain Barré syndrome, or GBS, a potentially fatal inflammatory disorder. By the time she was hospitalized in mid June, Mari was essentially paralyzed. Mari was intubated and placed on mechanical ventilation. For weeks on end, Mari’s condition remained unchanged. She was heavily sedated, unable to move, and entirely dependent on mechanical ventilation for survival. In August, there were indications of slight improvement, and the very slow process of weaning Mari off mechanical ventilation began. At the outset, it was not clear that the process was successful. Through incredible effort on Mari’s part, she was fully weaned off mechanical ventilation by August, and discharged to a rehabilitation facility. She spent more than two months at the rehabilitation facility diligently attempting to re-acquire the ability to speak, breathe, and move her arms and legs on her own. She was discharged home in November, still in need of essentially 24-hour care. Since that time, she has worked every day toward achieving her goal, as yet unreached, of walking again. Medical expenses to date exceed $1,000,000.

Nicole Riggs developed an E. coli O157:H7 infection in May 2008 from consumption of raw goat’s milk. She was nine years old at the time. Nicole suffered from symptoms typical of E. coli O157:H7 infections – bloody diarrhea, cramping, and nausea – that quickly intensified and led to her hospitalization. Once hospitalized, Nicole developed renal failure, anemia, and thrombocytopenia (low platelet count) indicating that she was developing HUS. She was transferred to a Children’s hospital and started on dialysis in order to save her life. She received dialysis for 18 days. Nicole’s renal function slowly returned to the point that she was deemed healthy enough for discharge on June 1. After discharge, she remained under the care of a nephrologist. In addition, damage suffered during her HUS has required that her gall bladder be removed. Medical costs to this point exceed $180,000. As the result of damage to her kidneys suffered during her bout with HUS, Nicole is at significant risk for severe renal complications in the future.

I certainly understand the desire of a farmer to sell a highly profitable product, just as I can understand the desire of consumers to make up their own minds about drinking raw milk. But farmers and consumers need to be fully informed, and the risks need to be fully understood. Because of the debate and the risks, I helped fund the building of Real Raw Milk Facts as a place where the pro’s and con’s of raw milk production and consumptions can be discussed against the background of scientific facts.

Bottom line, be informed.

David Dinsmore of the Town Talk of Alexandria and Pineville Louisiana continues to report on the tragedy surrounding an outbreak of illnesses that sickened more than 40 people and killed three patients at Central Louisiana State Hospital. Mr. Dinsmore reports that test results found the third most common cause of food poisoning — clostridium perfringens — was to blame for the outbreak at Central earlier this month, said Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals’ Office of Public Health. The C. perfringens bacterium appears to have come from the chicken salad served before patients and staff members began getting sick, Holcombe said. Those who had the chicken salad at that time were 23 times more likely to show symptoms, which is a good indicator that the dish was the culprit.

Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution. (1)

Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. The symptoms are caused by ingestion of large numbers of (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation.

The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. In the elderly or infirm, those symptoms may often last 1-2 weeks. Complications and/or death only very rarely occur; a few deaths have been reported as a result of dehydration and other complications.

Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients. Standard bacteriological culturing procedures are used to detect the organism in implicated foods and in feces of patients. Serological assays are used for detecting enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The procedures take 1-3 days. (1)

Continue Reading Clostridium Perfringens tainted Chicken Salad linked to 40 illness and three deaths at Central Louisiana State Hospital

I have decided this week that the Tea Party movement is right – business and government in the U.S.A. are a bunch of damn socialists – at least they are when poisoning consumers and investigating outbreaks.

First, full disclosure. When I am not channeling Rupert Murdoch in my role as publisher at Food Safety News, I play an ambulance chasing super lawyer. Interestingly, in both roles, accurate, complete and timely information is the key to either a good story or a good lawsuit – and many times both.

So, what’s my point? Accurate, complete and timely information is the actual gas that makes the engine of our free market operate. In my world, where consumers get poisoned by the food they and their families eat, knowing the product and who poisoned you is important, not just so you know whom to sue, but also who not to buy from next time – or at least until they stop poisoning people. That is the free market operating effectively. With accurate, complete and timely information comes free choice that matters (versus free choice that is the equivalent of playing Russian roulette). Knowing who produces safe food allows consumers to vote with their dollars, making sure that the producers of unsafe food get voted out.

I am frustrated, however, that business and government seem so intent on keeping information from us. (Think of the scene in "A Few Good Men” where Jack Nicholson character yells “you can’t handle the truth!”) More specifically, I am frustrated that business and government in two recent foodborne illness outbreaks seem so intent in deciding what we need to know thereby putting sugar in our gas tanks and letting the free market engine grind to a halt.

Just over a month ago rumors started swirling in the upper-Midwest and beyond that leafy greens – specifically romaine lettuce was tainted with E. coli and Salmonella. First, it was rumored that the source was a Michigan Mexican-style restaurant, and then it was college food service. Eventually, an E. coli O145 outbreak was announced that has been linked to Freshway Foods, Andrew Smith and a Yuma Farm and thirty-some illnesses in Michigan, Ohio, Tennessee, New York and Pennsylvania. Now, over a month into the recall, the FDA, Freshway and Andrew Smith are silent as to the name of the Yuma Farm. Do they really not know? And, if they do not know, then why not? You must admit letting the public know that Yuma Farm is sending us pathogenic E. coli has value. Perhaps we can decide not to purchase from them again? Perhaps we can learn why it happened on that farm? Such knowledge becomes the engine for improving safety and, more importantly, letting the public make informed food choices.

So, let’s talk Salmonella and Fresh Express. We know that Fresh Express recalled their product after a bag of their lettuce product tested positive for Salmonella during retail sampling. By all accounts, Fresh Express has acted admirably in cooperating with the FDA. However, Fresh Express has also been linked to several Salmonella illnesses in the upper-Midwest that occurred before this recall, and having nothing to do with it. So, why the cone of silence over health departments? So, why no announcement by authorities, or Fresh Express, that Fresh Express product sickened people? Did they tell the sick people what product poisoned them? Why not tell the public? Shouldn’t the public have the right to know if food safety, industry leader, Fresh Express, is as fallible as the rest of lettuce producers? Doesn’t the free market require accurate, complete and timely information to allow consumers to know what they believe is safe for they and their families?

It is time for us all to act like good capitalists and turn away from the seduction of socialism, where government decides what the public needs to know, and when. Yes, it’s hard to tell the truth and to tell people things that are hard and perhaps embarrassing. But, that is the cost/benefit of living in a free society. Freedom requires information. Businesses and government have limited rights to hide information from us – especially when we are being poisoned by a foodborne illness.

The CDC reports a total of 28 individuals infected with a matching strain of Salmonella Newport have been reported from 10 states since March 1, 2010. The number of ill people identified in each state with this strain is as follows: AZ (2), CA (14), CO (1), ID (3), IL (1), MO (1), NM (1), NV (2), OR (1), and WI (2). Among those for whom information is available about when symptoms started, illnesses began between March 1, 2010 and May 7, 2010. Case-patients range in age from <1 to 75 years old, and the median age is 32 years. Sixty-four percent of patients are female. Among the 20 patients with available hospitalization information, 6 (30%) were hospitalized. No deaths have been reported.