As with any joke, it will have some basis in reality. Microbiologists spend some time with microscopes, and while I've never literally chased an ambulance, I make my living representing people who have spent time inside ambulances.

My parents were teachers, so I took my education very seriously and aspired to become a lawyer. I studied my share of science, but I gravitated toward law and politics, and it would be some years before science became a crucial component in my work. I studied political science, English and economics at Washington State University (WSU) and while still in school, I was elected to the Pullman City Council--the youngest person and first WSU student to be elected to that office. I went on to law school at Seattle University, receiving my law degree in 1987 and from there I joined a Seattle law firm.

Six years later, my career took off when I represented many of the families injured by the infamous outbreak of E. coli O157:H7 linked to undercooked hamburgers at a chain of restaurants in the USA. Eventually the company settled for millions of dollars, which helped those families deal with the medical consequences to their loved ones, and enabled me to set up my own firm, and a new direction.

My firm specializes in cases involving foodborne illness. As the founding partner, I oversee a staff of about 20, including seven lawyers. Over the years we have represented thousands of people and families injured by E. coli, Salmonella and other potentially harmful microbes, and we are involved in virtually every outbreak across the USA. In many respects, my job is similar to other lawyers--dealing with clients and opposing lawyers, gathering information, negotiating settlements, and sometimes trying cases in court. The main difference is that I am also deeply involved in consumer education and in the political effort to reduce the risk of foodborne illnesses.

My days usually begin before 5 a.m., when I spend 90 minutes or so responding to emails, monitoring developments in my firm, and posting new items on my personal blog--Marlerblog.com, and several other informational sites that have become an important part of my work. By the nature of my specialty, I rely heavily on advances in science. My job would be far more difficult, if not impossible, without the advances made in food safety and microbiology. ‚Ä®

The most obvious way we interact with scientists is through culture and isolation of bacteria, the very foundation of foodborne illness detection and surveillance. Molecular microbiology methods, such as pulse field gel electrophoresis (PFGE), allow us to build solid claims on behalf of our clients. To represent our clients, we must be able to trace a foodborne illness to its source, whether that is a pizza parlor in Florida or a meat processing plant in Nebraska, and that source must be established with enough certainty that a jury is left with little doubt about the source of an outbreak illness.

Until just a few years ago, this was difficult to establish. Outbreaks of Salmonella or E. coli O157:H7 or other serious illnesses were generally investigated by interviewing victims and searching for a common denominator--a local restaurant or scouts club or church event. In a complex society, it was difficult to detect widespread outbreaks, let alone trace those outbreaks to a specific source. PFGE changed everything. This method establishes a DNA "fingerprint" that distinguishes specific strains, confirming that these people were sickened by this batch of hamburger or that batch of peanut butter.

PulseNet is a nationwide network of state and local public health agencies, coordinated by the Centers for Disease Control, which enables epidemiologists and public officials to detect national outbreaks that might normally be missed. So both the science and bureaucracy surrounding PFGE help us to represent our clients far more effectively.

There are other less obvious, but equally important ways in which we use microbiology. The popular misconception of my work goes something like this: somebody feels they have been injured or damaged, so they hire a lawyer, who argues the case before a judge and jury who awards them a great deal of money. Case closed. In fact our work is much more complicated.

Every day, we hear from people who believe they have been sickened by foodborne illness. They have a stomach ache, or diarrhea, or their grilled cheese sandwiches "tasted funny" or "didn't look right." They read in the newspaper about an outbreak of foodborne illness linked to grilled cheese sandwiches, and they say: "Ah ha! Obviously, that's what made me sick." So they call us. Some of those people have legitimate claims, but most are not supportable. The illnesses may be psychosomatic, or coincidental, or downright fraudulent, and the first task of a good lawyer is to sift through the claims and determine which cases are sound.

As I mentioned, most claims are not supportable, and we reject the great majority. When lawyers fail to use good judgment in assessing these claims, there are repercussions throughout the system. No lawyer can make a living by arguing false or fraudulent claims; it merely wastes his own time and money, that of his clients and the courts, and that of the companies forced to defend them. Pursuing illegitimate claims undermines the system, so that the food industry is more likely to deny legitimate claims by people who have actually been sickened by their products. This, in turn, makes it more difficult to push through important measures that would improve food safety. In the long run, pursuing false claims only increases the risk that more people will get sick.

Our first task is to weed out the fraudulent complaints and thereby increase the chances of achieving success with the legitimate ones. For foodborne illness claims, we have developed a series of legal and scientific screens, derived from years of experience. Here are some of the factors we consider:

Incubation period: When claimants say the hamburger they ate this morning sickened them, they are generally out to lunch. Incubation periods--the time between eating and the onset of symptoms--are only ranges, and wide ranges at that. But they are still important. So, the claimant who says she got E. coli O157:H7 from today's hamburger simply does not have a winnable case, because of the incubation period for E. coli O157:H7 (one to ten days, typically two to five days). In 2004, a claimant who had stopped for a cheese sandwich contacted us saying: "within two hours of eating that sandwich I became very ill," he wrote. "My fever went up from 98.6 to 100.2; I got diarrhea, stomach cramps, headache and chills. I am still very sick... can you please help me?" The answer was, no. Based on incubation periods, this person's lunch from this restaurant is most likely not the source of his illness. The major culprits--Salmonella, Shigella, Campylobacter, or E. coli O157:H7--all are subject to incubation periods longer than two hours, which rules out the cheese sandwich.

Smell and taste: other potential claimants complain that something they ate tasted funny, or didn't smell right. We try to be sympathetic, but most bacteria are odorless and tasteless, and customers who suspect a meal because it tasted funny are usually wrong. Others file what we call "gross-out" claims. In one case, a consumer complained that she had opened a box of "buffalo wings" and "an unusually shaped piece caught my eye... when I saw that the piece had a beak, I got sick to my stomach. My lunch and Diet Coke came up and I managed to christen my carpet, bedding and clothing. I want them to at least pay for cleaning my carpet etc. What do you think?" We thought she chose wisely not to eat the wings, but this is probably not a legitimate personal injury claim.

Health department investigations: while statutes and regulations vary from state to state, most health departments monitor outbreaks of foodborne illness. In most cases, a positive lab result from a human sample triggers a report to the local health authority and some type of follow-up investigation. The length, breadth, and documentation vary depending on the pathogen involved, the type of food, the number of persons who may be sick, the local jurisdiction, and other factors. Usually, the results of the investigation are either made public by the health authorities or can be obtained through public records.

It is difficult for food-processing companies to dispute such investigations. Rarely has a defendant avoided liability where the local health department concluded that the defendant's food was the source of an outbreak. In general, public health officials are extremely cautious not to prematurely assign blame for an outbreak. They operate with a much higher burden of proof than the civil justice system. Most epidemiologists require 95 percent confidence in a particular conclusion, while a jury requires only 51 percent confidence. Take, for example, the E. coli outbreak at a school in eastern Washington State in 1998. Local and state health officials concluded that the source of the outbreak was a ground-beef taco meal prepared and served at the school. We represented the families of 11 children who were identified as victims of the outbreak. All but one of them attended the school. Four of the children developed hemolytic uremic syndrome (HUS), which resulted in varying degrees of permanent kidney damage. However, the child with the most severe injuries did not attend the school and did not eat the implicated meal. Health officials concluded that she had been infected through exposure to her sister or another student--a secondary infection. The school district disagreed, but in doing so, the district had to challenge the health department's conclusions. The case went to trial, and testimony by health department officials proved to be crucial in the jury's decision in favor of the plaintiffs.


Health officials will not report a confirmed outbreak, or pinpoint a restaurant or supplier as its source, without being virtually certain of that conclusion. Without 95 percent confidence, based largely on PFGE and other biological analyses, they are likely to identify outbreaks as possible but not certain. That standard of evidence works both ways; if health officials conclude that an outbreak did not come from a particular source, plaintiffs face an uphill battle to prove their case.

Prior health inspections: most state and local health departments enforce health regulations by inspecting restaurants and other food services, and imposing fines or other sanctions for violations. These inspections provide an important tool for establishing the source of an outbreak. Documents may include reports of prior incidents or accusations of food contamination, and those documents can be acquired through the discovery process or through public record requests.

Health department documents may provide evidence of improper food handling, suggesting how food may have become contaminated. They may help document a history of improper techniques and code violations that can serve as a tool for limiting a defendant's trial options. Such documentation can lead to an early and favorable settlement, and a history of repeated violations can build a case for punitive damages.‚Ä®

When consumers claim to have been sickened by restaurant meals, health officials or lawyers may find contaminated leftovers, but that is unusual. Far more frequently, lawyers will build their cases on a documented pattern of health code violations. For example in 2001, a young girl suffered a particularly severe E. coli O157:H7 infection. She had eaten a hamburger at a California fast-food chain. But, by the time health officials investigated, the original case of frozen hamburgers was long gone, and officials did not find any food on site that tested positive for E. coli. However, a thorough review of the restaurant's current and prior inspections revealed a crucial flaw in the firm's cooking method. In six reports spanning three years, health officials had warned the restaurant of the dangers of cross contamination. The matter settled shortly after the presentation of this information.


Clearly, advances in microbiology have helped the world understand which pathogens cause illnesses, foods that are vehicles for transmission of pathogens, and how those illnesses can be avoided. Those advances make it easier for public health and the legal system to trace an outbreak of illness to its source, and to impose sanctions that encourage food processors to minimize risk. This is one of the ways that science and the law conspire to make the world a safer and better place to live.


The author would like to thank the Society for Applied Microbiology for permission to reprint this article, which first appeared in the June 2010 issue of Microbiologist Magazine.

So, what do you do?

After being involved in every major (and a few minor) food poisoning outbreaks since the Jack in the Box outbreak of 1993, I have seen it all. I have seen good CEOs act badly and make their and their company's problems worse and I have seen bad CEOs handle the outbreak with such aplomb that they become associated with both food safety and good PR. So, what do you do?

Of course, it is always best to avoid the outbreak to begin with. When I have spoken to CEOs or their Boards--generally, pre-outbreak and pre-lawsuit--I always pitch them on "why it is a bad idea to poison your customers." Putting safe food as the primary goal--yes, alas, even before profits--will (absent an error) give you a very, very good chance of never seeing me on the other side of a courtroom.

But, what if despite your best efforts, or what if you simply did not care, and an outbreak happens, what do you do?

First, have a pre-existing relationship with the folks that regulate you. If someone holds your business in the palm of his or her hand, you should at least be on a first name basis. No, I am not suggesting that you can influence your way out of the outbreak, but knowing who is telling you that your company has a problem allows you the ability to get and understand the facts. Do regulators and their investigators make mistakes? Perhaps, but not very often and not often enough to waste time arguing that your company did not poison customers.

Second, stop production of the implicated product and initiate a recall of all products at risk immediately. This procedure should have been practiced, and practiced, and practiced before. All possibly implicated suppliers should be alerted and all retailers should be offered assistance. Consumers need to be engaged too.  The goal now is to get poisoned product out of the marketplace and certainly out of the homes of consumers.

Third, launch your own investigation with two approaches, and at the same time. Are the regulators correct? And, what went wrong? Tell everyone to save all documents (you have to anyway). The goal here is to get things right. If it really is not your product, what has happened is bad, but survivable. If it really was your product, then learning what happened helps make sure it is likely to never happen again. More than anything, be transparent. Tell everyone what you find--good or bad.

Fourth, assuming that the outbreak is in fact your fault, publicly admit it. If it is not your fault, then fight it. However, pretending that you are innocent when you are actually at fault will get you nowhere. Asking for forgiveness is not a bad thing when you have something to be forgiven for. Saying you are sorry is not wrong when you are in fact wrong.

Fifth, do not blame your customers.  If you food has a pathogen it is not your customers responsibility to handle it like it will likely kill them or a member of their family.  Hoping that the consumer will fix your mistake takes your eye off of avoiding the mistake in the first place.

Sixth, reach out to your customers and consumers who have been harmed. Offering to pay legitimate losses will save money and your company's reputation in the long run.

Seventh, teach all what you have learned. Do not hide what you have learned. Make your knowledge freely available so we all limit the risk that something similar will happen again.

Yes, you can do all of the above and still get sued. And, I might be the one to sue you. Yet, companies who have followed the above find their passage through an outbreak, recall, and litigation temporary. The companies that struggle for unfounded reasons will seldom exist in the long run, or they will simply pay me more money.

… the final vote of 247 to 170 broke almost strictly along party lines, with only five Republicans voting for the measure even though a senior Republican responsible for tax issues acknowledged that there were positive aspects to the bill. … Representative Sander M. Levin said: … “You say you agree with these provisions, but then you’re going to vote no,” … “You just don’t apparently want to be caught being bipartisan. It’s going to blur the political message.”…

The phenomenon has shown itself in the Senate as well in the current impasse over a package of tax breaks and safety-net spending. Extending unemployment benefits in times of economic duress used to be a popular vote, but not one Republican was willing to join Democrats on Thursday to break a filibuster holding up added jobless pay. …

Representative Michael N. Castle of Delaware, … said the gulf between the parties had grown so wide that most Republicans simply refused to vote for any Democratic legislation. …

“It is just the politics of the time,” said Mr. Castle, who is running for the Senate. “We are just into a mode where there is a lot Republican resistance to voting for anything the Democrats are for or the White House is for. I think part of it is where the polling is and how things seem to be going from a political point of view. It is an election year.”… If Republicans were to vote for Democratic legislation, it would represent a tacit acknowledgment that some Democratic ideas merit support — not the message Republicans want to send right now. They are working hard to portray Democrats as inept and themselves as a worthy alternative. …

So, is it because the Republicans have positioned themselves as “the party of no” that a bill like S. 510, the Food Safety Modernization Act has not seen a floor vote after passing out of the H.E.L.P. committee by a unanimous vote several months ago? Could a bill that passed without a no vote now be the victim of “party politics?” Is it possible that despite H.B. 2794 Food Safety Enhancement Act bi-partisan passage in the House almost a year ago, that its Senate version will not receive a vote?

Would Republicans, if given the chance to vote on S. 510 (remember, the Democrats hold a 59 to 41 vote margin and hold the reins of the legislative agenda) actually vote against it? Would they really say no (or, “hell no”) to the first major piece of food safety legislation in generations and ignore that they sicken 76,000,000 citizen/voters yearly food they eat? Really? Would Republican’s vote no to solidify their no narrative? I am not so sure.

First, a confession. I am a life-long Democrat. I have never voted for a Republican and I have given and raised millions for Democratic candidates (a large number of the phone calls I receive are candidate solicitations). However, I am not so sure that S. 510’s failure to pass can be set at the feet of the Republicans.

I think there are two things at play in the Democratic camp – both equally disturbing to a Democratic fundraiser, a guy who has testified before Congressional Committees and someone who has brought numerous clients poisoned by tainted food to add color to the Committee theatre.

First, that the Democratic leadership does not have the Democratic votes to pass this landmark legislation. With farm state Senators being seduced by the Tester’s small farm amendment and the liberals by Feinstein’s BPA amendment, perhaps Reid and the rest simply do not have the votes to pass the legislation?

Second, so what if Reid has the votes, but not the kind he wants? What if this bill actually has more Republican votes than Democratic ones? What if on this bill the Republicans want to say yes, but doing so would both show that the Democrats are not united and the Republicans are no the party of completely no. Yes, it does seem clear that the Republicans are intent on keeping to their narrative of no. But, perhaps the Democrats do not want to give the Republicans a chance to be bi-partisan?  Perhaps the Democratic narrative would be compromised by too many Republican yeses.

So, there is no Santa and politics is nasty and stupid. It really took me 53 years to figure that out?

In the last month the FDA has been investigating an E. coli O145 outbreak that has sickened some 30 people in Michigan (11 confirmed and 2 probable), New York (5 confirmed and 2 probable), Ohio (8 confirmed and 3 probable), Pennsylvania (1 confirmed), and Tennessee (1 confirmed). The outbreak has been linked to Fresh Way Foods, which purchased romaine lettuce from Andrew Smith Co., who distributed the romaine lettuce from “THE FARM IN YUMA” - still unnamed.  And, so much for traceability.

At about the same time health departments in the “Upper-Midwest” investigated and confirmed a link between several Salmonella illnesses and the consumption of lettuce products from Fresh Express, a subsidiary of Chiquita Brands International Inc. There was NO recall - why?

The failure of the FDA to name “THE FARM IN YUMA” and for health departments to remain mum on illnesses and to issue NO recall is puzzling in the “Era of Transparency.” This seems especially true now with the new FDA “Transparency Task Force” – “[whose] goal is to facilitate transparency that promotes public health and innovation,” said Joshua Sharfstein, M.D., FDA principal deputy commissioner and chair of the Transparency Task Force. “These proposals reflect a careful balancing of the importance of transparency with the importance of protecting trade secrets and confidentiality.”

Perhaps trade secrets and confidentiality trump public health?

Food Safety – If it can happen to Fresh Express?

Having nothing directly to do with the illnesses in the “Upper-Midwest”, yesterday afternoon Fresh Express recalled several types of ready-to-eat salads after Salmonella was found in a package tested by the U.S. Food and Drug Administration. The products in question include lettuce mixes, Caesar salad and other salad kits, hearts of romaine and other items. Fresh Express said the FDA found a single package of the salad tested positive for salmonella. The recall is for salads and lettuce packages that contain romaine lettuce, have "use by" dates of May 13 through May 16 and an "S" in the product code and that were sold in 26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Fresh Express has clearly been a leader in food safety. I have attended a few of their food safety conferences and have been impressed with their commitment to safer salads. Their Fresh Express Scientific Advisory Panel is without question some of the best in the business:

• Dr. Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy, University of Minnesota, Chair
• Dr. Jeff Farrar, DMV, PhD, MPH, California Department of Public Health (Now at FDA)
• Dr. Bob Buchanan, PhD, formerly of the U.S. Food and Drug Administration, now director, Center for Food Systems Security and Safety, University of Maryland
• Dr. Robert Tauxe, MD, MPH, U.S. Centers for Disease Control and Prevention
• Dr. Bob Gravani, PhD, Cornell University
• Dr. Craig Hedberg, PhD, University of Minnesota

In addition, just last week Fresh Express received from the International Association for Food Protection (IAFP) the 2010 prestigious Black Pearl Award. Sponsored by Wilbur Fagan and F & H Food Equipment Company, the Black Pearl Award will be presented at the IAFP 2010 Annual Meeting in Anaheim, California in August.  This honor is given annually to one company for its efforts in advancing food safety and quality through consumer programs, employee relations, educational activities, adherence to standards, and support of the goals and objectives of IAFP.

So, if a Salmonella outbreak – regardless how small – and a recall caused by a positive Salmonella test in its product – can happen to Fresh Express, what does that tell us about food safety in the leafy green industry?

I was pleasantly surprised this morning reading the 2009 CDC FoodNet data from MMWR (Yes, Morbidity, Mortality Weekly Review – Seriously) on the plane back from Washington D.C - perhaps.

Along with the FDA, FSIS, and 10 state health departments, the CDC has been tracking illnesses caused by nine food-borne pathogens since 1996 (three years post Jack-in-the-Box) through the FoodNet program. According to its 2009 report in MMWR, illnesses caused by E. coli O157:H7 have dropped by 25% over the past three years and are at their lowest levels since 2004. David Goldman, MD, MPH, administrator of FSIS, attributed much of the E. coli O157:H7 decline to meat processors (since last year) being required to test all components of meat used in ground beef. In addition, around the same time, inspectors received new guidelines for evaluating sanitation in meat processing plants. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a2.htm).

David, that did not work out so well for young Abby Fenstermaker and her family in 2009 - did it?

Abby’s hemolytic uremic syndrome illness, and her Grandfather's illness (note, he is presently on life support), 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.

However, perhaps the good work at FSIS is not the real reason for the drop in the number of ill?  Perhaps we simply stopped counting the real number of E. coli O157:H7 cases?

According to the CDC itself, the number of state health department epidemiologists, and the tasks they can perform, have decreased since 2006, according to a study published by the CDC in MMWR on Dec. 18, 2009. (www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a1.htm). The report indicated that the reduction in health departments' epidemiology capacity was due in part to diminished federal public health preparedness funding, and states' overall budget cuts. Annual grants to states through federal preparedness funding decreased from a high of $1 billion in 2002 to approximately $698 million in 2008. The reduction coincided with a decrease in bioterrorism/emergency epidemiology and surveillance capacity, the report states. For physicians, this means less guidance on how to treat public health emergencies, and more patients with illnesses that potentially could have been prevented had data been available, the report said.  So, less funding, fewer epidemiologists means you count fewer E. coli O157:H7 cases?  How convenient - the fewer you count, the better you look.

So, a 25% decrease in E. coli O157:H7 illnesses at the same time state health department epidemiologists are decreasing? Hmm, sounds like “fuzzy math” to me.

Despite what seems like daily food recalls and weekly foodborne illness outbreaks, we still - as does the President, Congress, the FDA and FSIS – believe that growers, shippers, manufacturers and retailers are not really out to poison us.

Not to sound paranoid, but don’t you think our beliefs are a bit misplaced? For god’s sake, the CDC says 76,000,000 people are sickened, 325,000 are hospitalized and 5,000 die every year in the U.S.A., because the food they ate was tainted with some pathogen - bacteria or virus. You would think that if we had a nearly 1 or of 4 chances of being sickened by the food we eat yearly, we would have quickly lost trust in our food supply.

Frankly, many of us have.

The tale of tomato bribery and corruption outlined in the articles are shocking, but they are really no more or less shocking than Peanut Corporation of America (PCA) poisoning 700 and killing nine fellow citizens by selling Salmonella-tainted peanut butter and covering up the test results? And, we are still waiting for the criminal prosecution of the president of PCA, Stewart Parnell - we likely will continue to wait.

Also, how different really is the Cargill E. coli outbreak of 2007 that paralyzed 20-year-old dancer, Stephanie Smith, or the 2009 Valley Meats E. coli outbreak of 2009 that eventually lead to the death of 7-year-old Abby Fenstermaker? What about the Nebraska Beef E. coli outbreak in 2006 that killed Caroline Hawkinson at a church supper? What about another Nebraska Beef E. coli outbreak in 2008 that burned through South Georgia nearly taking the life of Evelyn Stewart and several others? And, what about Linda Rivera, who has been hospitalized since May 2009 after eating E. coli-tainted cookie dough?

Those are just the tip of a very nasty food poisoning iceberg, and only a few years snapshot of the outbreaks that stretch back into my legal life. Perhaps there were no bribes; perhaps there were no falsified test results, but there were warnings ignored, shortcuts taken, investments not made, and customers’ safety ultimately ignored. Why? Because, we let them.

The thing about food - unlike most other products – is that, like water and air – we need food to survive. That leaves us with very little leverage in a complex, over fed (in some countries) and under fed (in many others), and over populated world, where we are more and more disconnected to food. Today we rely of a long chain of distribution to feed us. We trust the chain to feed us and not poison us. We trust that it is in the chains’ economic self-interest to not kill us off. We trust the Government to watch our backs. Why? Because, we have to.

Many try to break the chain of growers, shippers, manufacturers and retailers and go “locavore” – to buy food within 100 miles of home (forget bananas in Minneapolis in the winter).

Some have moved so far away from what most American’s recognize as our food chain, as to go from organic, to natural, and then to raw. Word to the wise – not all of the 76,000,000 sickened eat CAFO raised, mass-produced, mega-corporate food. Sometimes local, raw milk, sprout or leafy green farmer Bob - much like (pick a nasty corporation) - does a very efficient job of poisoning his customers.

Yes, on average I think growing your own is safer than leaving it up to Wal-Mart or McDonald’s to decide what to sell you. But, with a world population moving rapidly past six billion, I am not sure we can solely rely on Bob or my tomatoes and zucchini to feed the world.

So, what’s the solution? Yes, I support more inspection, enforcement, criminal prosecution, and, my personal favorite - suing the hell out of companies who poison people. But, all of that will not catch as many problems than if everyone in the food chain – short or long – would simply take a deep breath and ask, “would I feed this to my kid?”

Sue, thank you for sponsoring House Bill 54 (a.k.a., The Wyoming Food Freedom Act) – where can I send my check for your re-election?

The Bill, if enacted, would exempt producers from licenses, inspections and certifications when selling directly to consumers.

Sue, this Bill will be a big help for my struggling business and certainly allow me to spend more time in Wyoming suing those exempt producers, who, unlicensed, uninspected and uncertified are bound to poison their customers. I can also imagine that most of those producers are farmers and ranchers with little or no insurance to cover what can be millions in medical bills for poisoned children – I have always wanted a ranch in Wyoming – perhaps near a ski resort and trout stream? Sue, you are the best. Perhaps I can host a raw milk and hamburger fundraiser for you out at the new ranch?

The Wyoming Tribune Eagle (a.k.a, “liberal media”) has been giving some coverage to the bill. Michelle Dynes just wrote, “Food bill moves on to full House.” As he penned:

House Bill 54 would exempt producers from licenses, inspections and certifications when selling directly to consumers. The Wyoming Food Freedom Act also would encourage the expansion and availability of farmers' markets, roadside stands and farm-based sales….

Now that is a money move - Cha-ching!

Those damn Op-ed folks at the same paper do not seem to have the same view of food safety as Sue. The editors posted, “Food bill is conservatism run amok” a few days ago. The editors do not seem to like Sue’s “assert[ion] that the bill ‘seeks to clarify the fundamental right of Wyoming citizens to eat whatever they want to eat.’” The editors assert that they:

… can't find anything in the Wyoming or U.S. constitutions that even talks about what people should be able to eat. If there is a "fundamental right" to eat whatever you want -- and to peddle it -- it is so only in the mind of ultra-conservatives who think any form of governmental action is interference in their lives. …

Ms. Wallis would have you believe that the government has no right to meddle in interactions between buyers and sellers. But buyers, for the most part, believe the goods they are getting are safe -- at least partly because they have been inspected by the government.

Indeed, HB 54 takes the philosophy of "let the buyer beware" beyond the point of good sense: Who has the ability to test -- prior to consumption -- whether a food product is safe? …

The editors then resort to the old “nanny state” argument:

One of the key roles of government is to ensure the public welfare. Inspections of foodstuffs and licensing of sellers do just that. HB 54 is conservatism at its worst. It should be rejected.

Sue, do not pay any attention to the “liberal media” in Cheyenne, Wyoming. Pass the bill and I’ll see ya out at the ranch.

1. Tattoo on a body part that you use everyday FSIS’s Mission Statement:

The Food Safety and Inspection Service (FSIS) is the public health agency in the U.S. Department of Agriculture responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged.

2. Push for tax credits for workable food safety innovations for small, medium and large producers and support small and medium sized agriculture by growing local and regional markets for meat.

3. Meet with all major purchasers of meat, poultry and eggs (governments, ‘big box’ stores, fast food chains and retailers) and develop product specifications that mandate food safety and sustainability at a fair price.

4. Visit victims of foodborne illness outbreaks and bring along key FSIS staffers and industry leaders. Visit people like the parents of Abby Fenstermaker:

5. Develop uniform cooking, handling and labeling instructions that actually provide helpful guidance to the public (in contrast, for example, the suggestion to “cook thoroughly”).

6. Enforce a real zero-tolerance policy for E. coli O157:H7, non-O157 EHEC’s and all other antibiotic resistance bacteria on all meats.

7. Conduct meaningful sampling and surveillance at farms, slaughter facilities and retail to determine the real prevalence of all pathogens and provide that data to the public.

8. Post all Non-compliance Report (NR’s), product test results, other enforcement documents at manufacturing operations online in real-time (like restaurant health inspections are).

9. Create manufacturer quality certifications to aid consumers in making safe choices, and allow companies to capture price premiums for higher quality.

10. Increase food inspections. While domestic production has continued to be a problem, imports pose an increasing risk, especially if terrorists were to get into the act. Points of export and entry are a logical place to step up monitoring. We need more inspectors - domestically and abroad.

11. Make better use of our technology to ensure traceability of all food so that when an outbreak occurs authorities can quickly identify the source and limit the spread of the contamination and stop the disruption to the economy.

12. Improve surveillance of bacterial and viral diseases; First responders - ER physicians and local doctors - need to be encouraged to test for pathogens and report findings directly to local and state health departments and the CDC promptly.

13. Fire any FSIS employee that would believe and/or be quoted saying anything like:

“I have to look at the entire industry, not just what is best for public health.”

I am sure there are other ideas and even better ideas – If there was an Undersecretary of Food Safety I would suggest you email those to him or her.

In the last two years, about 44 million pounds of beef has been recalled for E. coli O157:H7 contamination.  Thousands of our friends and neighbors have been sickened and dozens have died.

So it was with interest that I was reading today Mandy Carr Johnson’s, Executive Director of Research, National Cattlemen’s Beef Association and Jeremy Russell’s, Director of Communications ‚Ä®and Government Relations ‚Ä®at the National Meat Association letters to the Editor of the New York Times in response to “More Perils of Ground Meat.”

I was struck by Jeremy's and Mandy's clear disconnect between their beliefs and the public’s perception of the beef industry, and what I experience on a daily basis representing the errors in “the safest food supply in the world.”

A few of Jeremy’s points:

- Furthermore, where there was a modest increase [of E. coli O157:H7] detected in raw ground beef components, Beef Products Inc.’s rate of positives is well below industry averages (0.05 percent for 2009 versus 0.99 percent).

Tell that to the hundreds of victims of E. coli O157:H7 outbreaks and recalls I met in 2009.

- Beef Products’ technology, which has been approved by both the Department of Agriculture and the Food and Drug Administration — as is thoroughly set forth on its Web site — provides consumers safe products.

So, why again did the National School Lunch Program stop buying the product and the FSIS remove the testing for E. coli O157:H7 exemption?

Mandy’s comments, however, started me thinking a bit more:

- E. coli O157:H7 and other food-borne threats are tough, adaptable foes. But the people who raise and package beef share a commitment to aggressively finding and applying safety solutions that keep them out of our food.

- Beef farmers and ranchers alone have invested more than $28 million since 1993 in beef safety research, and the industry as a whole invests an estimated $350 million a year on safety.

Assuming that those numbers are correct (and I might even assume that they are even higher), why not help the industry that is trying to help itself? Goodness, how many millions, billions, or is it trillions, have we given to bailout the banks and the auto industry?

What if we gave the beef industry tax credits for food safety interventions that actually work? What if we paid to have all downer cattle removed from the food supply? What if we helped fund the field tests for vaccines against E. coli O157:H7 that are underway on both sides of the border - the Bioniche vaccine approved for use in Canada and the Epitopix vaccine has the green light in the U.S? Irradiation? What if we funded research on E. coli O157:H7’s relationship to CAFO’s? Or, more research on grass vs grain fed beef and E. coli O157:H7? Or, pilot projects regionalizing meat production and slaughter? And, dozens of other ideas?

You get my point?  I tell you what, I'll walk arm in arm with Jeremy and Mandy through the halls of Congress if they had a plan that would work.  Jeremy, Mandy, you know my number.

Perhaps the Chicken, Hog and Lamb folks too?

When I was a kid in the early 60’s, I recall that goods stamped “Made in Japan” meant cheap, and also sub-par in quality and "Made in US" meant the best.  Interesting how that has changed (compare Japanese made cars to those in US for quality and sales).

More recently, in my world, we continue to hear fears of food made “overseas” – food from China or Mexico – that is somehow unsafe, or less safe than food produced in the US. Yes, there have been instances of foreign food products sickening Americans (melamine in dog and cat food from China, Salmonella in cantaloupes from Honduras, Hepatitis A in green onions from Mexico), but in 17 years of being involved in every foodborne illness case, most of the food products that sicken us are home grown and mass-produced. As I have said more that a few times, “US corporations do a marvelous job of poisoning us.”

It seems that other countries are now paying attention to what we sell (or try to) them. Perhaps, like me in the 60’s, they think “Made in the US” means something far different that what the producers and manufacturers would wish.

Look at the recent dust-up over chicken in Russia – “Putin Wants Poultry Supply Secure by ’15:”

Russia may stop importing poultry by 2015, Prime Minister Vladimir Putin said Thursday, backing a ban imposed on U.S. chicken imports at the beginning of the year. “We haven’t seen any readiness to meet Russian standards on the part of some of our partners, mainly the companies from the United States,” he said, chairing a meeting on poultry production in Snegirevka, in the Leningrad region. “If our foreign suppliers are unable or reluctant to meet our security requirements, we will use other sources,” he said, Interfax reported.

Perhaps Putin is playing to the Russia poultry industry (goodness, we never see US politicians doing the same here.), or, perhaps he read Consumer Reports a few months ago when it found:

… of 382 whole chickens bought from more than 100 stores in 22 states, found that two-thirds harbor disease-causing bacteria—salmonella, campylobacter or both. While one name brand, Perdue, and most air-chilled organic chickens were significantly less contaminated than Foster Farms and Tyson brand chicken, consumers still need to be extremely vigilant in handling and cooking chicken. …

When our tests found 44 percent of the chickens from the best performing major brand of chicken, Perdue, were contaminated with one or both pathogens, and 80 percent of the chickens from the most contaminated brands we tested—Tyson and Foster Farms—had the bacteria, the industry cannot be regarded as providing sufficiently safe and wholesome food. The industry must and can do better, and the USDA must establish the standards and enforcement mechanisms to ensure that outcome.

And, what about Asia? The latest controversy over “Made in the US” can be found in “Taiwan Bans Some U.S. Beef Imports.” Apparently Taiwan politicians:

… reinstate[d] a ban on American ground beef and offal reflected public concern that Taiwanese health officials lack sufficient safeguards to prevent mad cow disease a brain-wasting disease in cattle that in humans can cause a variant form, Creutzfeldt-Jakob Disease.

True or not, can you blame them for being a bit worried over US beef after reading, “Safety of Beef Processing Method Is Questioned.” Here are a few choice lines:

… The Beef Products case reveals a schism between the main Department of Agriculture and its division that oversees the school lunch program, a divide that underscores the government’s faltering effort to make hamburger safe. The U.S.D.A. banned the sale of meat found to be contaminated with the O157:H7 strain of E. coli 15 years ago, after a deadly outbreak was traced to Jack in the Box restaurants. Meat tainted with salmonella is also a hazard. But while the school lunch program will not buy meat contaminated with salmonella, the agriculture department does not ban its sale to the general public.

Even so, E. coli outbreaks nationwide have increased in recent years. And this summer, two outbreaks of particularly virulent strains of salmonella in hamburger prompted large recalls of ground beef across several states. …

Beef Products maintains that its ammonia process remains effective. It said it tests samples of each batch it ships to customers and has found E. coli in only 0.06 percent of the samples this year.

The company says its processed beef, a mashlike substance frozen into blocks or chips, is used in a majority of the hamburger sold nationwide. …

Carl S. Custer, a former U.S.D.A. microbiologist, said he and other scientists were concerned that the department had approved the treated beef for sale without obtaining independent validation of the potential safety risk. Another department microbiologist, Gerald Zirnstein, called the processed beef "pink slime" in a 2002 e-mail message to colleagues and said, “I do not consider the stuff to be ground beef, and I consider allowing it in ground beef to be a form of fraudulent labeling.”…

Trade war? Perhaps, or not. However, you must admit that the meat industry and our own government is handing the stick to allow foreign politicians to beat the meat industry in the head. Seriously, “salmonella, campylobacter” in large percentages of chicken in our stores, and “pink slime" that someone in our own government “consider[s] the stuff to [not] be ground beef, and I consider allowing it in ground beef to be a form of fraudulent labeling.”…

“Made in USA” used to mean something different.  Someone should be paying attention.

Given that there are other bugs, namely Enterohemorrhagic Non-E. coli O157:H7, that cause human illness and death, I petitioned the FSIS to deem these pathogens as adulterants. I have followed up, once and twice with FSIS and intend to seek intervention in the courts in March if FSIS refuses to act.

As I also said in an earlier post, “with several recent recalls of Salmonella-tainted beef in 2009 and recent reports of Salmonella-tainted chicken, getting a better understanding of Salmonella - especially Antibiotic Resistance in Salmonella - is a good way to start off the New Year.” Perhaps the FSIS should consider these nasty bugs (antibiotic-resistant Salmonella) adulterants as well? Perhaps another petition is on order? Keep reading below and give me your thoughts.

Salmonella is a leading cause of foodborne illness worldwide, with an estimated 1.4 million cases each year in the United States alone (1). Salmonella infections are typically due to consumption of food products of animal origin. Several lines of evidence indicate that antibiotic-resistance among human Salmonella infections results from the use of antimicrobial agents in food animals (2). Below is an overview of antibiotic-resistance and Salmonella and what it means for human health.

Antibiotics and drug-resistance

Many bacterial species have the ability to produce antimicrobial compounds. This ability is needed to give the bacteria an “edge” in microorganism-rich environments. Many of the antibiotics used today originated from bacterial species such as Pennicillium, Cephalosporium, and Streptomyces. Antibiotic-resistance likely also emerged as bacteria began producing compounds in order to survive in their environment, and competing species found ways to counteract these compounds (3).

Antimicrobial agents are currently used for three main reasons: (1) to treat infections in humans, animals, and plants; (2) prophylactically in humans, animals, and plants; and (3) subtherapeutically in food animals as growth promoters and for feed conversion (2). When antibiotic use became the norm in both human and animal medicine, selection pressure increased the bacterial advantage of maintaining and developing new resistance genes that could be shared among bacterial populations (3).

The first suggestion that antibiotic use in livestock led to antibiotic-resistant bacteria was in 1951. Starr and Reynolds reported streptomycin resistance in generic intestinal bacteria from turkeys that had been fed that antibiotic (4).

The use of antibiotics not only selects for antimicrobial-resistant bacteria, but may also increase the likelihood of disease transmission. In 2006, Bauer-Garland et al. researched the transmission of multidrug-resistant (MDR) Salmonella Typhimurium in broiler chicks under selective-pressure. An MDR S. Typhimurium strain had significantly increased transmission when chicks were treated with tetracycline, demonstrating that antimicrobial use influences transmission of antimicrobial-resistant pathogens in poultry (5).

Antibiotics and Salmonella

Although most Salmonella infections are self-limited, causing acute gastrointestinal illness in humans, antimicrobial agents are commonly prescribed to those seeking medical attention. Severe infections that spread to the bloodstream, meningeal linings of the brain, or other deep tissue can also occur. The selection of effective antibiotics is critical for the treatment of invasive infections, but has become more difficult as antibiotic-resistance has increased (2).

In the 1980’s and 90’s, a particular strain of MDR Salmonella, known as Salmonella Typhimurium DT104 (DT104), emerged in the U.S. This strain is typically resistant to at least five drugs: ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (6). Since 1996, the National Antimicrobial Resistance Monitoring System (NARMS) has identified increasing numbers of Salmonella isolates resistant to nine of the 17 antimicrobial agents tested: amoxicillin/clavulanate, ampicillin, cefoxitin, ceftiofur, cephalothin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline. These isolates also have decreased susceptibility or resistance to ceftriaxone, an antimicrobial used to treat serious infections in children (7). Salmonella isolates with this resistance pattern carry a gene that produces AmpC-type enzymes that cause much of the drug-resistance; thus they are referred to as MDR-AmpC.

Salmonella Enteritidis is one of the most common types of Salmonella causing human illness, and is associated with consumption of egg-containing products and chicken (8). Since 1996, an increasing number of S. Enteritidis isolates submitted to NARMS have been resistant to nalidixic acid (a drug closely related to ciprofloxacin, or cipro, the most commonly prescribed antibiotic for Salmonella infections). Of these resistant isolates, 90% also showed decreased susceptibility to cipro (7).

Use of antibiotics in agriculture

Antibiotics are used in food animals for several reasons: treatment of sick animals, prophylaxis to prevent illness during times of increased risk of disease (e.g. transport or weaning), a combination of treatment of sick animals and preventative care for other animals in the herd or flock, and for growth promotion and improved feed utilization. The total amount of antibiotics used in food production animals in the U.S. is not known (3).

Antimicrobial agents have played an important role in animal production since the 1950’s. As livestock and poultry farms have grown and animal density on those farms has increased, the demand for better disease management has increased. The use of antimicrobial agents in animal production has improved animal health and led to higher yields. However, this practice has also contributed to the increased prevalence of antibiotic-resistant bacteria significant to human health (3).

The rising prevalence of MDR Salmonella complicates the treatment of Salmonella infections in both humans and animals. A call for prudent use of antibiotics in both human and animal medicine has been issued for years, with some positive results. In 2005, the U.S. Food and Drug Administration (FDA) placed a ban on the use of enrofloxacin (a drug closely related to cipro) in poultry because of the risk that it promotes drug-resistant bacteria that are harmful to human health (9). Opponents to banning antibiotic use in animal agriculture have pointed out that bans like these have, in some cases, led to increased animal morbidity and mortality, and have sometimes contributed to a greater use of antibiotics to treat ill animals. These other antibiotics may come from drug families of greater relevance to human medicine than the drugs that were banned (3).

New data also suggests that use of cephalosporins in the poultry industry could be impacting clinical use in humans. In July, 2008, the FDA proposed a ban of veterinary use of cephalosporins for unapproved methods (such as injection of eggs in hatcheries) due to the likely emergence of cephalosporin-resistant strains of foodborne bacterial pathogens (10). Since cipro is not approved for treatment of Salmonella infections in children under 18 years of age, cephalosporins are an important treatment option for severe infections (11). The American Veterinary Medical Association (AVMA), which represents both public and private sector veterinarians, argued that the FDA’s proposal was unjustified. FDA withdrew the proposal in November, 2008 in order to reconsider all available data on the subject (10).

Antibiotic-Resistant Salmonella in the Food Supply

Antibiotic-resistant Salmonella have been isolated from various food products. In 1998, 20% of ground meat samples were positive for Salmonella, and 84% of these were resistant to at least one antibiotic in the Washington, D.C. area (12). From 1999 to 2003, 18% of Salmonella isolates from various food products tested by the FDA were resistant to two or more antimicrobials (13).

A case-control study of Salmonella Newport infections in the U.S. found that MDR-AmpC infections are acquired through the U.S. food supply from bovine and possible poultry sources (14). Between 2004 and 2005, processed poultry from the mid-Atlantic area of the U.S. was positive for Salmonella in high numbers. Eighty percent of positive samples were resistant to at least one antimicrobial and 53% were resistant to three or more antimicrobials (15). In 2005, Salmonella was detected on 72% of broiler chicken carcasses prior to evisceration and on 20% of carcasses postchill in a sample of 20 U.S. processing plants. Only 15% of the S. Typhimurium var. 5- isolates were pan-susceptible, and more than half of these isolates were resistant to three or more antibiotics (16). In 2006, 22% of raw and ready-to-eat turkey meat purchased in a Midwestern U.S. city was positive for Salmonella. Of these isolates, 62% were multidrug-resistant (17). These results clearly show that MDR Salmonella are present in the food supply, and continued monitoring and research is necessary to track these alarming trends.

Human Infections

Several studies have been published focusing on the severe health consequences from multidrug-resistant Salmonella infections. In 2002, Helms et al. reported on a study in Denmark looking at antibiotic-resistant S. Typhimurium. Patients with MDR infections were 4.8 times more likely to die than the general population, and patients with quinolone-resistant infections were 10.3 times more likely to die (18). In 2004, Helms also reported that patients with quinolone-resistant S. Typhimurium infections had a two-fold increased risk of invasive illness or death within 90 days of infection compared to patients with pan-susceptible infections (19).

Also in 2004, Martin et al. reported on Canadians with MDR S. Typhimurium infection. Hospitalization was more likely in those with MDR infections, and the majority of these hospitalizations were directly attributed to the resistance patterns of the infections (20).

In 2005, Varma et al. published data on bloodstream infections and hospitalizations. Patients infected with a Salmonella isolate resistant to one or more clinically important antibiotic were three times more likely to be hospitalized with a bloodstream infection than patients with pan-susceptible infections (21).

Outbreaks

Several outbreaks of multidrug-resistant Salmonella infections have been documented in the United States, including an outbreak associated with unpasteurized Mexican-style aged cheese (22), ground beef outbreaks (23, 24, 25, 26), and an outbreak associated with pasteurized milk (27).

In one investigation, hamburger was traced back through meat processing to well beef cattle that had been fed antibiotics (23). In another investigation, chloramphenicol-resistant S. Newport was traced through processing of contaminated ground beef to a dairy farm area. Chloramphenicol-resistant Salmonella was found in manure lagoons, abattoirs, ill dairy cattle, and ground beef. Isolation of chloramphenicol-resistant Salmonella was correlated with chloramphenicol use on the farms (24).

Outbreaks like these can result in multiple hospitalizations and death among individuals with the most severe infections. The multidrug-resistant nature of these organisms makes treatment failure more likely. Antimicrobial agents, particularly fluoroquinolones like cipro, are lifesaving for approximately 2,000 people each year in the U.S. If even 10% of Salmonella isolates in the United States were to become resistant to cipro, and 5% of persons with invasive cipro-resistant infections were to die, the result would be an increase of 10 deaths per year. If 50% of strains became resistant, an additional 100 deaths per year would be expected (2).

Conclusions

There are several reasons to conclude that antibiotic-resistance among human Salmonella isolates are the result of the use of antimicrobial agents in food animal production: (1) tracebacks from foodborne disease outbreaks have shown food animals as the ultimate source of infection (outbreak refs), (2) antimicrobial resistance patterns and genetic fingerprints have shown strong correlation between animal and human Salmonella (2, 6), and (3) antibiotic-resistance in human Salmonella isolates have shown more correlation with antibiotic use in animals than with antibiotic use in humans (2).

Dissemination of MDR Salmonella appears to contribute to changes in resistance patterns. In the U.S., there aren’t restrictions on movement of animal herds positive for S. Typhimurium, though the purchase of infected animals is known to be a risk factor for dissemination. Routine surveillance and intervention (including traceback and quarantine) has reduced the incidence of salmonellosis in food animals in Europe, specifically Norway and Sweden. Biosecurity measures, including protection of feed from rodents and birds, limiting human traffic, disinfection, and separation of newly purchased animals from the larger herd or flock, in addition to testing and quarantine would reduce the risk of introducing MDR Salmonella into a herd or flock. Addressing this issue would subsequently help prevent the unimpeded spread of MDR Salmonella through food animals with consequent human foodborne infection (28).

Some of the same farm management strategies that could help to prevent foodborne disease could also help prevent MDR Salmonella from circulating in the food supply. It ultimately comes down to cost vs. benefit at every step in the chain of responsibility among food producers. Farmers and their veterinarians should be responsible for judicious use of antibiotics in the animal industry just as physicians should be judicious in their use of antibiotics in human medicine. Farmers also need to implement biosecurity measures as outlined above to address problem of dissemination of MDR Salmonella in addition to other infectious agents. In an ideal world, slaughter and food manufacturing facilities would also follow suit, using the best possible practices to minimize foodborne disease transmission to consumers, and federal regulatory agencies would monitor each step in the overall process to ensure the best food safety practices possible. If the problem of antibiotic-resistance is not controlled, larger outbreaks with more severe consequences can be expected. Considering MDR Salmonella to be an official “adulterant” in foods would be a prudent step in helping to curb this emerging foodborne disease threat.

References

1. Swaminathan B, Gerner-Smidt P, and Barrett T. 2006. Foodborne Disease Trends and Reports: Focus on Salmonella. Foodborne Path and Dis. 3(2):154-156.
2. Angulo F, Johnson K, Tauxe R, and Cohen M. 2000. Origins and Consequences of Antimicrobial-Resistant Nontyphoidal Salmonella: Implications for the Use of Fluoroquinolones in Food Animals. Microbial Drug Resist. 6:77-83.
3. Matthew A, Cissell R, and Liamthong S. 2007. Antibiotic Resistance in Bacteria Associated with Food Animals: A United States Perspective of Livestock Production. Foodborne Path and Dis. 4(2):115-133.
4. Starr MP and Reynolds DM. 1951. Streptomycin resistance of coliform bacteria from turkeys fed streptomycin. Am J Public Health. 41:1375-1380.
5. Bauer-Garland J, Frye JG, Gray JT, Berrang ME, Harrison MA, and Fedorka-Cray PJ. 2006. Transmission of Salmonella enterica serotype Typhimurium in poultry with and without antimicrobial selective pressure. J Appl Micro. 101:1301-1308.
6. Wedel SD, Bender JB, Leano FT, Boxrud DJ, Hedberg C, and Smith KE. 2005. Antimicrobial-drug Susceptibility of Human and Animal Salmonella Typhimurium, Minnesota, 1997-2003. EID. 11(12):1899-1906.
7. CDC. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS): Human Isolates Final Report, 2006. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, 2009.
8. Voetsch AC, Poole C, Hedberg CW, Hoekstra RM, Ryder RW, Weber DJ, et al. 2009. Analysis of the FoodNet Case-Control Study of Sporadic Salmonella serotype Enteritidis Infections Using Persons Infected with Other Salmonella Serotypes as the Comparison Group. Epidemiol Infect. 137(3):408-416.
9. CIDRAP: University of Minnesota Center for Infectious Disease Research and Policy. 2005 News release available at: http://www.cidrap.umn.edu/cidrap/content/fs/food/news/july2905baytril.html
10. Webster, P. 2009. Poultry, Politics, and Antibiotic Resistance. Lancet. 374(September 5):773-774.
11. American Academy of Pediatrics. Salmonella Infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book 2009 Report of the Committee on Infectious Diseases. 28th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:(584-588).
12. White DG, Zhao S, Sudler R, Ayers S, Friedman S, Chen S, et al. 2001. The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats. NEJM. 345(16):1147-1154.
13. Kiessling CR, Jackson M, Watts KA, Loftis MH, Kiessling WM, Buen MB, et al. 2007. Antimicrobial Susceptibility of Salmonella Isolated from Various Food Products, from 1999 to 2003. J Food Prot. 70(6):1334-1338.
14. Varma JK, Marcus R, Stenzel SA, Hanna SS, Gettner S, Anderson BJ, et al. 2006. Highly Resistant Salmonella Newport-MDRAmpC Transmitted through the Domestic U.S. Food Supply: A FoodNet Case-Control Study of Sporadic Salmonella Newport Infections, 2002-2003. JID. 194(15 July):222-230.
15. Parveen S, Taabodi M, Schwarz JG, Oscar TP, Harter-Dennis J, and White DG. 2007. Prevalence and Antimicrobial Resistance of Salmonella Recovered from Processed Poultry. J Food Prot. 70(11):2466-2472.
16. Berrang ME, Bailey JS, Altekruse SF, Shaw Jr WK, Patel BI, Meinersmann RJ, and Fedorka-Cray PJ. 2009. Prevalence, Serotype and Antimicrobial Resistance of Salmonella on Broiler Carcasses Postpick and Postchill in 20 U.S. Processing Plants. J Food Prot. 72(8):1610-1615.
17. Khaitsa ML, Kegode RB, and Doetkott DK. 2007. Occurrence of Antimicrobial-Resistant Salmonella Species in Raw and Ready to Eat Turkey Meat Products from Retail Outlets in the Midwestern United States. Foodborne Path and Dis. 4(4):517-525.
18. Helms M, Vastrup P, Gerner-Smidt P, and Molbak K. 2002. Excess Mortality Associated with Antimicrobial Drug-Resistant Salmonella Typhimurium. EID. 8(5):490-495.
19. Helms M, Simonsen J, and Molbak K. 2004. Quinolone Resistance is Associated with Increased Risk of Invasive Illness or Death during Infection with Salmonella serotype Typhimurium. JID. 190(1 November):1652-1654.
20. Martin LJ, Fyfe M, Dore K, Buxton JA, Pollari F, Henry P, et al. 2004. Increased Burden of Illness Associated with Antimicrobial-Resistant Salmonella enterica serotype Typhimurium Infections. JID. 189(1 February):377-384.
21. Varma J, Molbak K, Barrett T, Beebe J, Jones T, Rabatsky-Ehr T, et al. 2005. Antimicrobial-Resistant Nontyphoidal Salmonella Is Associated with Excess Bloodstream Infections and Hospitalizations. JID. 191(15 February):554-561.
22. CDC. 2008. Outbreak of Multidrug-Resistant Salmonella enterica serotype Newport infections associated with consumption of unpasteurized Mexican-style aged cheese – Illinois, March 2006-April 2007. MMWR. Apr 25;57(16):432-5.
23. Holmberg SD, Osterholm MT, Senger KA, and Cohen ML. 1984. Drug-resistant Salmonella from Animals Fed Antimicrobials. NEJM. 311:617-622.
24. Spika JS, Waterman SH, Soo Hoo GW, St. Louis ME, Pacer RE, James SM, et al. 1987. Chloramphenicol-resistant Salmonella Newport Traced through Hamburger to Dairy Farms. A Major Persisting Source of Human Salmonellosis in California. NEJM. 316:565-570.
25. CDC. 2006. Multistate Outbreak of Salmonella Typhimurium Infections Associated with Eating Ground Beef – United States, 2004. MMWR. Feb 24;55(7):180-2.
26. Dechet AM, Scallan E, Gensheimer K, Hoekstra R, Gunderman-King J, Lockett J, et al. 2006. Outbreak of Multidrug-Resistant Salmonella enterica serotype Typhimurium Definitive Type 104 Infection Linked to Commercial Ground Beef, Northeastern United States. CID. Mar 15;42(6):747-52.
27. Olsen SJ, Ying M, Davis MF, Deasy M, Holland B, Iampietro L, et al. 2004. Multidrug-resistant Salmonella Typhimurium Infection from Milk Contaminated after Pasteurization. EID. May;10(5):932-5.
28. Davis MA, Hancock DD, and Besser TE. 2002. Multiresistant Clones of Salmonella enterica: The Importance of Dissemination. J Lab Clin Med. 140(3):135-141.

When I returned in 1996 as a Governor appointed Regent (I am sure it had nothing to do with the fact that I was the campaign finance chair for Gary Locke’s – now Commerce Secretary – successful bid for Governor) more than a few administrators wondered what they might be getting in a new boss. Frankly, like many who make a few dollars and inhabit boards, I thought I was quite mellow in the eight years I served (for the most part).

But I digress, this post is supposed to be about Michael Pollan and his visit to Pullman.

I bumped into Michael yesterday during his hour long Q and A with students. It was the first time that I had actually had the opportunity to meet “food jesus” although we had many acquaintances in common, including Eric Schlosser, Marion Nestle and Barbara Kowalczyk, among others. We had dinner together served by the hospitality program at the University – all organic and local as possible (salmon was from Alaska). It was then off to a nearly packed venue (about 4,000) for his talk (more on the substance later) that was very well received. This morning we shared a bus to the Pullman airport at 5:00 AM. We split in Seattle, he to do another speech, me to the seamy side of food - back into E. coli, et al.

Personally, I found Michael, bright, engaging, reasonable and with a child-like curiosity of things – like “what is a Big Mac” really made of?”

This morning’s media did focus a bit too much on the apparent controversy of the reading of "The Omnivore's Dilemma" and Michael’s off again, on again visit. From the Student Newspaper:

Next, someone asked Pollan about the controversy over his book at WSU.

Pollan said he had simply heard the problem was budget related, yet he was quick to stress the need for freedom of inquiry, especially in public schools.

"Freedom and inquiry goes right to the heart of what a university is ... ," he said. "This school has a powerful and illustrious agriculture college. And if we’re going to really change this food system and create a food system that contributes to the health of the population, it’s going to come out of places like this, (but only with) free and independent inquiry.”

The Lewiston Paper weighed in on that too:

"I wasn't sure I was coming for a while there," Pollan said. "A whiff of a certain controversy reached me down in California."

In March, a committee of WSU professors selected his book as its third annual Common Reading selection for more than 3,000 incoming freshmen. Former WSU Provost Robert Bates started the program to create unity among first-year students and help them transition into the intellectual life of a university.

But WSU soon decided to drop distribution of the book. It cited a $54 million state budget cut and said it could not afford the $40,000 cost to bring Pollan to campus the following spring.

Others suspected politics, however. "The Omnivore's Dilemma" is highly critical of large agribusiness, and one of WSU's regents -- Harold Cochran -- owns a 5,500 acre farm near Walla Walla. One media report cited fellow Regent Francois Forgette as saying Cochran objected to the selection of Pollan's book for the Common Reading program.

And English professor, Patricia Ericsson, The Chronicle of Higher Education an administrator cited political pressure as the reason the Common Reading program was canceled.

But then WSU alumnus William Marler stepped in with his checkbook. A nationally-known personal injury attorney in Seattle, Marler offered to pony up the money to bring Pollan to Pullman. WSU accepted and reinstated the Common Reading program.

Pollan's book is right up Marler's alley. A former president of the WSU Board of Regents, Marler now specializes in food safety issues.

Cochran declined a request for an interview from the Lewiston Tribune.

Pollan thanked Marler, who was sitting in the front row, for making his visit possible. "I don't know that I would have been here if not for his intervention."

Pollan added that he welcomed the controversy. "It's one of the reasons there are so many of you here," he said. "And it's a very good thing for this country, because we are at the beginning of a national debate, I think, about the future of food and farming in America."

But, to the "meat" of his talk.  Like many thought leaders (and Michael is clearly one), listeners tend to hear things that they really like or really do not, and they hear them from their own perspective and experience. 

I tend to listen and approach issues as an economist - what are the incentives that make people react and then act?  If you "distill" Michael’s "Sun Food Agenda" to its essence, it is an economic argument about sustainability.  How is it possible to have a cheap, oil based agricultural system (corn, soy and fertilizer) when oil is becoming more expensive - financially, politically and environmentally?  And, how is it possible to sustain cheap, calorie rich food when it costs billions of dollars in chronic health care?

These are the "weighty" issues that we can face now by adjusting how we produce and consume food, or the consequences will be imposed upon us or our children when oil prices collapse the food market or health care cost are flattened by the "weight" of the illnesses in our populations.

I believe that we can think our way out of this "Omnivore's Dilemma" and not have a future imposed on us. The place to do it is at Universities like Washington State University and that is why it was an easy investment - Go Cougs.

Marler, … says he and his firm, Marler Clark, have pried $500 million in settlements out of companies that have sickened customers. The vast majority of the firm's cases settle. "We have a lot of big cases, $7 (million) to $10 million cases," Marler said. "People don't just give you that kind of money unless you have your foot on their throat."

I won’t say that she did not believe that we had reached $500,000,000 in settlements in the last ten years, but she was skeptical. And, who could blame her. I mean, no matter how hard you look, you will find only one verdict (Finley E. coli O157:H7 Outbreak) and only a few settlements – Jack in the Box’s $15,600,000 settlement with Brianne Kiner, Odwalla’s $12,000,000 - $15,000,000 E. coli O157:H7 settlement, and a $11,000,000 E. coli O157:H7 settlement with BJ’s. Those settlement amounts only became public in part because of mistakes – the defense lawyer failed to seal the BJ’s court file and it appears that Odwalla leaked the settlement despite the parents of the children wanting the settlements to be confidential. The Kiner settlement was different – both sides, the Kiners and Jack in the Box, wanted the settlement to be public.

So, no wonder that Ms. O’Hagan questioned the settlement total. All three settlements that you can find, Kiner, Odwalla and BJ’s, were the exception to the general rule of confidentiality.

The “bottom line” is that defendants (a.k.a., companies that poison customers) and their insurers want confidentiality. Why? What food company really wants to admit that it paid money for poisoning someone? And, what insurance company wants to admit it paid any money at all to anyone at anytime?

As for victims, many agree to the defendant’s desire for confidentiality to get the money that is rightfully theirs for compensation for injuries, while others simply feel that the public does not need to know the amount of the settlement – in essence, a right to privacy.

The reality is that nearly all of the settlement agreements today contain a provision like:

Confidentiality. In further consideration of the payment to be made by Releasee, Releasors and their attorneys, including all individuals employed by or with the Releasors and/or their attorneys agree and represent that the existence of this Agreement, the Agreement itself, the terms of the Agreement, and the allegations of the complaint, are and shall remain confidential. Except as permitted below, Releasors and their attorneys agree that they will not disclose and have not in the past disclosed this Agreement or the contents thereof to any person, organization and/or entity, and will use their best efforts to insure that any such person who is permitted knowledge of the terms of this Agreement, will not violate the letter or spirit of this Agreement and the confidentiality provisions contained herein.

As I said, injured plaintiffs may desire privacy and therefore find confidentiality of settlements – especially for their children – beneficial. Defendants and insurers clearly benefit from secret settlements by both keeping, if they paid, and how much they paid, confidential.

However, does the public as a whole suffer from these confidential settlements?

What if a food company repeatedly causes harm and then covers up, not only the amount of the settlement, but also the cause of the outbreak, through a confidential settlement? And, how does the public benefit from allowing settlements by insurance companies to be secret - especially given that taxpayers have bailed several of these companies out?

However, what if each settlement amount was transparent? What if the media reported on the settlement? What if the public knew about the number of settlements and the amounts? Would it change legislator behavior? Would it change regulatory behavior? Would it change consumer-purchasing behavior? Would it change a companies investment it food safety?

I fear that as long as settlements are confidential we really will never know. Perhaps it is time for transparency?  From here on out, I will only agree to confidential settlements if the clients demand it.

For me personally, raw milk generates mixed images. Growing up on a farm, milking cows and consuming raw milk in the 1970s is one image. Thirty plus years later, however, my mind is drawn to images of children sickened by drinking raw milk. These children were sickened by bugs that we did not know existed in the 1970s. Each and every one of the parents who bought or served the raw milk thought that they were doing something good for their child. They believed that the “organic,” “natural,” “fresh,” and “raw,” nature of raw milk meant that it had properties that would be good for their child, not bring them to death’s door.

Presently, raw milk cannot be sold across state lines for human consumption. However, there have been multiple instances where raw milk producers have violated the law directly or have sold the milk as animal food knowing that humans were likely consuming it.

In-state raw milk sales are limited to about a dozen states, with most states limiting raw milk sales to direct farmer to consumer transactions. Many of the states that allow these direct sales are quick to point out the exceedingly low price of pasteurized milk, touting the high price a farmer can get for raw milk as a method of “helping the small, family farmer” – a laudable goal I might add. This goal, however, is not without risks to the consumer.

Over the past several years, I have represented several families of children whose parents purchased raw milk directly from the farmer. The children came away with E. coli O157:H7 bacteria-mediated Hemolytic Uremic Syndrome, months of hospitalization, hundreds of thousands of dollars in medical expenses, and millions of dollars in risk of future complications – including end stage renal disease and the need for multiple kidney transplants.

Some states allow “cow-shares” or, as I call them, “cow condos.” This is where non-farmers “buy” a portion of the cow (and its milk) and attempt to get around any law banning the sale of raw milk. Again, states rationalize allowing this ownership fiction as another way of supporting the cost of maintaining the “small, family farmer” – also, a laudable goal.

I currently represent a woman in California who “purchased” raw milk as part of a “cow-share” – albeit, an illegal one. The milk she consumed was contaminated with Campylobacter and she subsequently developed Guillain-Barre Syndrome. She was hospitalized for months, much of the while dependent on a ventilator. She is now, in essence, a quadriplegic. Her past medical bills are nearly one million dollars. Her cost of future care is in the tens of millions of dollars.

There are also a handful of states that allow retail (grocery store) sales of raw milk and raw milk products. This is capitalism at its finest. Raw milk in retail sells for about eighteen dollars per gallon. Organic pasteurized milk sells for less than half of that. Farmers want to sell their raw milk to a larger market as efficiently as possible and there is demand from consumers who would rather shop at their favorite market than drive to the farm or own a “condo cow.” In short, selling raw milk in a retail setting is the raw milk farmer’s Holy Grail. Even retailers love it, seeing as how it creates a consumer draw and has a nice mark-up.

I have represented (and still represent) victims of E. coli O157:H7 cases linked to raw milk purchased (some illegally) in retail settings. In Missouri, one consumer purchased raw goat milk that was being sold illegally – the consumer did not know that the sale was illegal. This sale led to the consumer’s child suffering severe Hemolytic Uremic Syndrome, being hospitalized for a month, and spending weeks on dialysis to save his life. He now faces a lifetime of risks that may likely cost millions of dollars.

In California, E. coli O157:H7-tainted raw milk sold in small “health food” retail outlets sickened several children. Two children developed severe Hemolytic Uremic Syndrome. Both spent over a month in the hospital, both on dialysis and one on a ventilator. Medical bills were nearly one million dollars. One child may require a kidney transplant – the other surely ill. The future costs to these children may well be several million dollars. 

I also presently represent two people (one child and one adult) from Connecticut who consumed raw milk purchased at a Whole Foods. The milk was tainted by E. coli O157:H7. Both developed Hemolytic Uremic Syndrome. Once again, hundreds of thousands of dollars in medical expenses have been incurred. One victim, a twenty-eight year old mother, will likely require a kidney transplant – again, at a multiple million-dollar cost.

Now for the risky part. Most, if not all, raw milk farmers have limited insurance and very few assets that are not owned solely by the bank. If they face litigation for poisoning a customer, bankruptcy is always an option and what insurance is available is paid.

But, what about the risk to the retailer? True, in selling raw milk they are “only” selling a product that has a history of sickening consumers – they did not manufacture it. So, is a retailer, like Whole Foods, liable for paying millions of dollars to its customers if they are sickened by raw milk? The short answer is – Hell yes!

The reality in most states is that the entire “chain of distribution,” whether you are a manufacturer (a farm is) or retailer, is responsible if a product (raw milk is a product) causes harm. That means the farmer, the shipper, and the retailer will be responsible (morally and legally) to the consumer for all damages caused by the product. It is true that, depending on the state, a court may apportion damages between various members of the “chain.” However, and this is key, if the original manufacturer (the farmer in this instance) is bankrupt or has limited assets (including insurance), the retailer may be left “holding the bag” – partially empty – that the retailer will need to fill.

By way of example – assume that raw milk sold at a Whole Foods sickens five people. Two develop Hemolytic Uremic Syndrome. Assume further that the farm has only one million dollars in insurance and limited assets. Also assume that the total value of all cases (settlement or verdict) is ten million dollars. Guess who pays the nine?

So, why would a retailer, like Whole Foods, sell raw milk? Perhaps eighteen dollars a gallon?

 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

"There are certain things only a government can do. And one of those things is ensuring that the foods we eat are safe and do not cause us harm.”

A few days ago I penned this Op-ed (declined by the Washington post) - it seems a bit more on point tonight after our President's speech:

Linda Rivera’s excruciating case of food poisoning (Severe Case Gives Context to Issue of Food Safety Washington Post 9/1/09) should shine some light on a crucial reality that is missing from most health care reform plans: you can’t fix America’s health care unless you provide Americans with a safe food supply.

The mother of six lies comatose in her Las Vegas hospital room as a consequence of eating cookie dough contaminated with E. coli O157:H7 - a vicious microbe previously associated with hamburger, spinach, lettuce, and raw milk as well as other products. But she is not an isolated case. According to federal health authorities, she is just one of the 76 million Americans sickened each year by tainted food, adding billions in costs to individuals, to food-producers and to our beleaguered medical system.

Yet food safety is rarely mentioned in the scream fest that has been national health care debate in and around Congress. In fact, our national squabble threatens to scuttle any hope for the much-needed food safety legislation that overwhelmingly passed the House this summer. The Food Safety Enhancement Act would give the Food and Drug Administration (FDA) the authority it needs to inspect food-processing plants and stop the distribution of food tainted with E. coli, Salmonella, Listeria or any of the other usual suspects. It would increase the agency’s ability to use emerging technologies to trace contaminated foods and additives back to their source, while imposing new safety standards on both domestic and imported food products.

The potential benefits - to our children, our parents, and our neighbors and to the U.S. economy - are enormous. While the food industry insists that we have the world’s safest food supply, the authoritative Centers for Disease Control suggest otherwise: 76 million sick people per year, 208,000 per day, 8,675 per hour. Most of those cases are relatively mild, but the CDC says 325,000 people will be hospitalized, and at least 5,000 of them will die of food poisoning.

Consider the costs to the health care system, such as it is. The Department of Agriculture estimates the combined medical costs, productivity losses, and the costs of premature death at a minimum of $6.9 billion per year. But that estimate excludes costs such as lost business opportunities, public costs, pain and suffering and much more. The Food and Drug Administration assigns a cost of $5 million per death, reaching a total cost of $17 billion per year. But using a more complex FDA formula that factors in the full societal cost, the savings reach an astronomical $357 billion.

There may be argument over the calculations, but these are not paper costs; they are real. In the 17 years I have been representing the victims of food-borne illness, we have collected more than $500 million in settlements and verdicts against food manufacturers. Most of that goes to cover the costs of medical bills, lost wages and the pain and suffering incurred by people whose only crime was to believe processors` claims that their products were safe. So what if we passed meaningful food safety legislation? What if we saved billions of dollars in medical care and treatment by avoiding poisoning in the first place? What if Linda Rivera and thousands of Americans like her never became infected with E. coli or Salmonella or Listeria?

It’s time to tone down the rhetoric on health care and do something positive: pass meaningful food safety legislation that will put lawyers like me out of business, while saving money and the lives and well being of innocent Americans.

Dave Theno became head of Jack in the Box’s food safety shortly after the outbreak. I too have known Dave for 16 years. However, I only learned recently a significant fact about Dave – one that made me admire him even more – one that I think, not only that all leaders in corporate food safety should emulate, but one that both Secretaries Vilsack and Sebelius should pay attention too.

Dave and I shared the stage at the Nation Meat Association annual convention a few months ago. The NMA is an association representing meat processors, suppliers, and exporters. Dave, spoke just before I did and was rightly lauded as someone who takes food safety to heart. However, it was his story about Lauren Rudolph and his relationship with Roni that struck me. Dave told the quiet audience about Lauren’s death. Dave also told us that the death of Lauren and his friendship with Roni had changed him. He told us all that he had carried a picture of Lauren in his brief case everyday since he had taken the job at Jack in the Box. He told us that every time he needed to make a food safety decision – who to pick as a supplier, what certain specifications should be – he took out Lauren’s picture and asked, “What would Lauren want me to do?”

I thought how powerful that image was. The thought of a senior executive holding the picture of a dead child seeking guidance to avoid the next possible illness or death is stunning, but completely appropriate. I wonder if Secretaries Vilsack and Sebelius do anything similar when they do their work on President Obama’s Food Safety Working Group? If they do not, perhaps they should?

Secretaries Vilsack and Sebelius right now there are hundreds of families struggling right now due to illnesses and death related to food that you oversee that has been tainted with E. coli O157:H7.

Yesterday, I spent time with a family in South Carolina whose 4 year old ate cookie dough and suffered months of hospitalizations, weeks of dialysis and seizures. She faces a lifetime of complications. And, there is a woman in Nevada who is still hospitalized, who has lost a portion of her large intestine, was on dialysis until a few days ago. She faces months if not years of rehabilitation. Both ate cookie dough that was watch over by Secretary Sebelius’s FDA.

Today I sat across the kitchen table with a family who lost their only daughter because she died from an E. coli O157:H7 infection from meat inspected by Secretary Vilsack’s USDA/FSIS. I then visited families in a Cleveland hospital whose children are struggling in their battle against Hemolytic Uremic Syndrome – again E. coli O157:H7 tainted hamburger is to blame.

Secretaries Vilsack and Sebelius you should be like Dave Theno. Run your departments like Dave ran food safety at Jack in the Box. Go meet these families. Sit across their kitchen tables. Go to their child’s hospital room and see more tubes and wires than you can count. Understand what these people have lived though. Take their stories into your heart. It is hard, very hard, but it will give you a real reason to do your jobs.

At 10:00 PM last night between yet another story about Michael Jackson’s death, a foreign Network begin airing a video taken inside a manufacturing facility showing someone treating a batch of cookie dough with an unknown liquid. There is a claim that this is a terrorist act.

In the next 15 minutes, every network news operation is playing the video. The broadcast networks break into regular programming to air it, and the cable news stations go nonstop with the video while talking heads dissect it. Michael Jackson fades into the distance.

Coming on a Friday evening on the East Coast, the food terrorism story catches the mainstream Media completely off guard. Other than to say the video is being analyzed by CIA experts, and is presumed to be authentic, there isn’t much coming out of the government.

Far-fetched? Don’t count on it. I have been saying for years that a foodborne illness outbreak will look just like the terrorist act described above, but without the video on FOX News. Far-fetched?

Tell that to the 751 people in Wasco County, Oregon—including 45 who required hospital stays---who in 1984 ate at any one of ten salad bars in town and were poisoned with Salmonella by followers of Bhagwan Shree Rajneesh. The goal was to make people who were not followers of the cult too sick to vote in county elections.

Tell that to Chile, where in 1989, a shipment of grapes bound for the United States was found laced with cyanide, bringing trade suspension that cost the South American country $200 million. It was very much like a 1970s plot by Palestinian terrorists to inject Israel’s Jaffa oranges with mercury.

Tell that to the 111 people, including 40 children, sickened in May 2003 when a Michigan supermarket employee intentionally tainted 200 pounds of ground beef with an insecticide containing nicotine.

Tell that to Mr. Litvenenko, the Russian spy poisoned in the UK with polonium-laced food.

Tell that to Stanford University researchers who modeled a nightmare scenario where a mere 4 grams of botulinum toxin dropped into a milk production facility could cause serious illness and even death to 400,000 people in the United States.

The reason I bring this up is not to mark another anniversary of 9/11, not because I actually think that food terrorism really is the cause of this week’s E. coli cookie dough outbreak, but I wonder if it would have made any difference in our government’s ability to figure out there was an outbreak, to figure out the cause, and to stop it before it sickened so many.

After 9/11, Health & Human Services Secretary Tommy G. Thompson said: “Public health is a national security issue. It must be treated as such. Therefore, we must not only make sure we can respond to a crisis, but we must make sure that we are secure in defending our stockpiles, our institutions and our products.”

Before Thompson’s early exit from the Bush Administration, he did get published the “Risk Assessment for Food Terrorism and Other Food Safety Concerns.” That document, now 5-years old, let the American public know that there is a “high likelihood” of food terrorism. It said the “possible agents for food terrorism” are:

• Biological and chemical agents
• Naturally occurring, antibiotic-resistant, and genetically engineered substances
• Deadly agents and those tending to cause gastrointestinal discomfort
• Highly infectious agents and those that are not communicable
• Substances readily available to any individual and those more difficult to acquire, and
• Agents that must be weaponized and those accessible in a use able form.

After 9/11, Secretary Thompson said more inspectors and more traceability are keys to our food defense and safety. To date, we’ve made little movement to ensure this.

Would the fact of terrorists operating from inside a manufacturing facility somewhere inside the United States bring more or effective resources to the search for the source of the E. coli? If credit-taking terrorists were putting poison on our cookies, could we be certain Uncle Sam’s response would have been more robust or effective then if it was just a “regular” food illness outbreak?

Absolutely not! The CDC publicly admits that it manages to count and track only one of every forty foodborne illness victims, and that its inspectors miss key evidence as outbreaks begin. The FDA is on record as referring to themselves as overburdened, underfunded, understaffed, and in possession of no real power to make a difference during recalls, because even Class 1 recalls are “voluntary.” If you are a food manufacturer, packer, or distributor, you are more likely to be hit by lightening than be inspected by the FDA. You are perfectly free to continue to sell and distribute your poisoned product, whether it has been poisoned accidentally or intentionally.

The reality is that the cookie dough E. coli outbreak is a brutal object lesson in the significant gaps in our ability to track and protect our food supply. We are ill prepared for a crisis, regardless of who poisons us.

Somewhere between the farm and your table, our Uncle Sam got lost.