Header graphic for print
Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Raw Milk, a potentially risky elixir

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

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

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

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

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

Over the last several years I have tried to bring some level of rationality to the debate over the consumption of raw milk. I first published on my blog a summary of the findings of a review of peer-reviewed literature on the topic of the "pros" of the consumption of raw milk. Most alleged benefits were anecdotal, with a reduction in allergies as the only scientific observation. I then posted about the "cons." The overwhelming “con” of drinking raw milk, according to the scientific literature, relates to the serious risk of infection, and the injury, disability, and death that result.

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

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

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

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

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

Bottom line, be informed.

  • A couple of weeks ago I posted a blog looking for the elusive middle ground for raw milk. It is not going to go away so we should take the issue on and look for solutions. Better it be tightly regulated than to return to the days of prohibition! See my comments below:
    Raw Milk, Food Safety and the FDA
    Posted: Wednesday, May 12th, 2010
    http://leavittpartners.com/news/raw-milk-%e2%80%93-food-safety-and-the-fda/
    By David Acheson.
    Managing Director Food and Import Safety,
    Leavitt Partners LLC
    The issue of consuming raw milk has become one of extreme polar views. The raw milk advocates extol the virtues of raw milk and are typically convinced that any risk associated with the consumption of raw milk is far outweighed by the benefits. On the reverse side, there are many who feel that those drinking raw milk are doing it without full recognition of the dangers or the seriousness of the risks they are taking.
    This debate has reached the point where the opposing sides are irrevocably dug in and equally unmovable in their convictions. Neither side will back down, and neither side is willing to look for compromise. While one has to respect the passion and the conviction of the opposing forces one also has to recognize that this situation has all the makings of continued anguish and wasted energy. The FDA has made their position very clear- that the movement of raw milk in interstate commerce is illegal and the Agency has taken action when such transgressions have come to light.
    As a public health professional I certainly appreciate the dangers of exposure to the microbial pathogens that may be found in raw milk. I personally do not drink raw milk and nor do I intend to. However I also realize that there are many very motivated individuals with a great capacity to solve problems that are devoting energy to the fight of their particular conviction rather than looking for a public health oriented solution.
    Let us accept that raw milk consumption is here to stay legislating against it will drive it underground and thus magnify any dangers associated with consuming that commodity. Instead, I advocate devoting the energy that abounds in this argument to setting agreed standards for raw milk production. There is copious science to indicate how to minimize the likelihood of microbial contamination of milk (note I say minimize and not eliminate). Appropriate management of the farm, the dairy cattle, the procedures, the containers, the storage and the shelf life of the product can all be effective controls and should all be used in conjunction with each other. Dare I even suggest that FDA could actually be a knowledgeable contributor to this process?
    States that allow the sale of raw milk need to set very high standards and most importantly enforce them. I believe many consumers of raw milk are aware of the dangers of raw milk consumption so they would likely welcome minimizing the risk through tight standards. Raw milk should be required to be labeled as such with appropriate warnings and to be required to be certified to those high standards before being allowed for sale to the public. The public should be educated about the need to only consume raw milk from operations that are following those very high standards.
    The battle over raw milk will continue to result in a public health stale mate until the intellectual capital of those involved in the argument move to a different level and look for collaborative solutions not confrontational ones. Confrontation will never succeed in this argument, but collaboration could not only be constructive but actually make the product less of a public health hazard which after all is my goal as a public health professional.

  • Anon

    I agree that consumers should be informed about raw milk; but I do not believe that it should be banned or outlawed. My family and I have been drinking raw milk for years and have never had a single problem with it; we believe its health benefits are superior to anything that’s been pasteurized, ultra-pasteurized, homogenized and further processed to enhance the flavor that’s been tortured out of it. Would a reasonable compromise be selling it in retail establishments but with prominent warning labels printed on each bottle?

  • A warning like this?
    “WARNING: This product has not been pasteurized and may contain harmful bacteria (not limited to E. coli O157:H7, Campylobacter, Listeria and Salmonella). Pregnant women, infants, children, the elderly and persons with lowered resistance to disease (immune compromised) have the highest risk of harm, which includes Diarrhea, Vomiting, Fever, Dehydration, Hemolytic Uremic Syndrome, Guillain-Barre Syndrome, Reactive Arthritis, Irritable Bowel Syndrome, Miscarriage, or Death, from use of this product.”
    One problem is that not many children (target for milk consumption) can read and understand these warnings.

  • Sam

    My friends and I have been playing Russian roullette “…for years and have never had a single problem…”

  • Doc Mudd

    *”My friends and I have been playing Russian roullette ‘…for years and have never had a single problem…'”*
    Yep, we hear ya, Sam – only takes one teensy weensy little “problem”.
    Spin…click, spin…click, spin…click, spin…
    Game not suitable for children aged 17 and under.

  • Rob

    @Bill Marler
    They should also put that label on pasteurized milk to with additional writing saying: -Due to the pasteurization process we’ve killed off all the enzymes that kick the above mentioned bacteria’s asses and apologize in advance if you get any contaminated pasteurized milk that has no way of protecting itself anymore. But don’t worry, we won’t mention you in any statistics stating how infectious pasteurized milk is. It’ll be our little secret.-
    Turds