Islamic State leaders are reportedly asking its followers to carry out terror attacks by poisoning food in Western supermarkets.  It is not like poisoning our food has not happened before and we certainly have been warned.  In 2011 Secretary of State Hillary Clinton warned of infectious disease outbreaks caused by pathogens falling into the wrong hands and into our food. She said:

“Unfortunately the ability of terrorists and other non-state actors to develop and use these weapons is growing. Therefore this must be a renewed focus of our efforts.”

“Because there are warning signs and they are too serious to ignore.”

“Al Qaeda in the Arabian Peninsula had urged brothers with degrees in microbiology or chemistry to develop a weapon of mass destruction.”

Sound familiar? It should. In 2004 Health and Human Services Secretary Tommy Thompson warned of food-related terrorist attacks. He said:

“For the life of me, I cannot understand why the terrorists have not attacked our food supply because it is so easy to do.”

It reminded me of an Op-ed I did for Forbes a year or so ago:

Imagine this: At 10:00 PM, after yet another story about Donald Trump, a foreign TV network begins airing a video taken inside a facility showing someone treating wash water in a cucumber packing house with an unknown liquid. There is a claim that this was the terrorist act that has so far sickened 341 and killed 2 in 30 states with Salmonella.

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. The Donald fades into the distance.

Coming on a Thursday 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.

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. I raise the issue not because I actually think that food terrorism is the cause of this week’s Salmonella cucumber outbreak. However, 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 some, but not enough 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 Salmonella? If credit-taking terrorists were putting poison on our cucumbers, could we be certain Uncle Sam’s response would have been more robust or effective then if it was just a “regular” foodborne 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 FDA 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. If you are a food manufacturer, packer, or distributor, you are more likely to be hit by lightning 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 cucumber Salmonella 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.

So, what can we do?  Since we inspect only about 1% of imported food that food could be tainted with biological or chemical agents before entering the United States. Given, also the lack of inspections domestically, toxins could easily be introduced in food at the farm, in transit, at processing plant or in restaurants.

More and better inspections by FDA and FSIA inspectors at various points in our food supply are absolutely necessary, as is good intelligence work by those at the CDC and FBI. However, when a terrorist uses a biological or chemical weapon against the civilian population – in food or otherwise, how quickly the outbreak is detected, analyzed, understood and addressed would be the responsibility of state and local public health offices and the CDC. Surveillance would be the key to limiting the damage and bringing the terrorists to justice.

We need to invest in the science of epidemiology and the surveillance of biological and chemical illnesses. We need to increase our laboratory capacity for biological and chemical agents, and our ability to quickly track patterns of potential illnesses. And, we need to strengthen the teamwork between state, local and federal health officials so outbreaks are caught early.

Perhaps a foodborne bio-terrorism event cannot be stopped, but with investments in surveillance, the event can be minimized.

Thanks to Blythe Bernhard and the St. Louis Post-Dispatch for recalling all the risk of past floods that will certainly be at play during and after Harvey

  • After the cleanup, wash hands with soap and warm water that has been previously boiled. Clothes should be washed in hot water and detergent, separately from clothes that aren’t contaminated. Use a laundromat if the wastewater system in the area has been compromised.
  • Open wounds and rashes can be any entry point for infection if exposed to floodwater. Use waterproof bandages and thoroughly wash any areas exposed to floodwater. Health officials recommend updated vaccinations for tetanus and diphtheria for anyone exposed to raw sewage.
  • Raw sewage in floodwater can carry bacteria, viruses and parasites. Those that can cause intestinal illness or gastroenteritis include strains of E. coli, salmonella, shigella and enterovirus. The main symptom of these illnesses is diarrhea, and those at higher risk of developing severe disease are the youngest and oldest in the community and people with compromised immune systems.
  • After the water recedes, mold can become another health concern. Remove and throw away any drywall or insulation that has been touched by floodwater or sewage. Mattresses, carpets, carpet pads, upholstered furniture, stuffed animals, pillows, books, paper products and anything else that can’t be washed and disinfected should be tossed out if they get wet.
  • Hard surfaces including flooring and countertops should be thoroughly cleaned with hot water and detergent. Any food that came in contact with floodwater must be discarded, even canned goods. All toys should be disinfected with a bleach solution.
  • People affected by flooding are also at risk of experiencing fear, anxiety and sadness. The American Psychiatric Association said anyone struggling with the emotions should seek professional help.

I dropped an Op-ed on the Hill this morning.  Here is an excerpt:

This week the CDC reported that at least 47 people were stricken with Salmonella, with one death, likely linked to papayas imported from Mexico. In the summer of 2016 came reports of hepatitis A tainted scallops sickening 292 in Hawaii. In that outbreak two died of liver failure complications. And, also in 2016, 143 people, mostly in Virginia, were also stricken with hepatitis A. This time the culprit was hepatitis A-tainted strawberries imported from Egypt.

While most food we consume is still produced in the United States, we rely on imports for some of our most nutritionally important but more risky commodities. And, imported food is increasingly taking a larger “bite” out of our food consumption. We now import over 90 percent of our seafood, 50 percent of our fresh fruit and 20 percent of our vegetables. Canada, Mexico, China and India are our top food trading partners. In 2014, we imported nearly $50 billion of food from just those four countries. Imports from all countries have increased, and that is especially true for China and India.

The Food Standards Agency of Scotland (FSAS) has announced that Macsween of Edinburgh Ltd has recalled a number of its products, including products manufactured for Lidl and Marks & Spencer, as a precautionary measure, because of concerns over the company’s procedures in place to control Clostridium botulinum.

FSAS reports that manufacturing controls that could potentially affect the safety of the products could not be demonstrated satisfactorily by the manufacturer. The issue relates to controlling factors to prevent the growth and toxin production of Clostridium botulinum. Botulinum toxin may cause a serious form of food poisoning called botulism and can be fatal.  A recall from customers is being carried out as a precautionary measure.

The recall concerns a wide variety of Haggis (Haggis is a savoury pudding containing sheep‘s pluck (heart, liver and lungs); minced with onionoatmealsuetspices, and salt, mixed with stock, traditionally encased in the animal’s stomach), as well as Black and White Pudding (White pudding is similar to black pudding, but does not include blood; both consists of pork meat and fat, suet, bread and oatmeal formed into a large sausage).

From my friends at the CDC who publish Morbidity, Mortality Weekly Review:

During 1975–2012, CDC surveillance identified 1,680 trichinellosis cases in the United States with implicated food items; among these cases, 1,219 were attributed to consumption of raw or pork products, and 461 were attributed to nonpork products. Although trichinellosis in the United States has historically been associated with consumption of pork, multiple nonporcine species of wild game also are competent hosts for Trichinella spp. and have been collectively implicated in the majority of trichinellosis cases since the late 1990s. During July 2016–May 2017, the Alaska Division of Public Health (ADPH) investigated two outbreaks of trichinellosis in the Norton Sound region associated with consumption of raw or undercooked walrus (Odobenus rosmarus) meat; five cases were identified in each of the two outbreaks. These were the first multiple-case outbreaks of walrus-associated trichinellosis in Alaska since 1992.

Trichinellosis is a parasitic disease that results from consumption of raw or undercooked meat infected by roundworm species in the genus Trichinella. Early signs and symptoms occur 1–2 days after ingestion and include diarrhea, abdominal pain, fatigue, nausea, and vomiting. Systemic signs and symptoms, which typically occur 1–2 weeks after ingestion and last for 1–8 weeks, include facial and periorbital edema, fatigue, fever (remittent) and chills, headache, muscle soreness, pruritus (with or without a rash), nausea, difficulty coordinating movement, neurologic complications, and cardiopulmonary impairment.

Lawyers Who Are Changing the World

By Jeff Tolman

I have great respect for people who take control of their lives and create a successful life and practice in the changing and evolving legal universe. That would be Bill Marler, Senior Partner at Marler Clark, The Food Safety Law Firm, in Seattle. Bill is considered the most prominent foodborne illness lawyer in America and a major force in food policy in the U.S. and around the world. Wondering if as a youngster he was innately interested in food and food poisoning – and, if not, how in the world he got into this niche practice – I gave Bill a call.

Bill grew up in Silverdale, WA, less than 10 miles from my office, the son of a Navy nurse and Marine Sergeant, both later teachers. After graduating from Olympic College in Bremerton, WA, Bill attended Washington State University. He graduated with three majors due to the fact he was elected to the Pullman City Council as a 19-year-old student and he was determined to fill out his term. After working as a paralegal in a Seattle law firm (Bog;e and Gates) for a year, Bill went to law school and received his J.D. from Seattle University School of Law in 1987. From 1987 to 1998 Bill worked in a variety of firms including Dick Krutch; McKay and Gaitan, Keller Rohrback; Perey Law Group; and Kargianis, Osborne, Watkins & Marler.

His first big civil case related to two children killed by Westley Allan Dodd. Bill decided to go right to the horse’s mouth and met with Dodd in the Washington State Penitentiary in Walla Walla, and for five hours heard about Dodd’s various contacts with the legal system. Determining the state of Washington had failed in its duty to monitor Dodd, resulting in the murders, a settlement was reached for the family of the victims.

Then came the 1993 E. coli outbreak at Jack-in-the-Box restaurants. Within a day Bill’s investigation led him to file a lawsuit and he became the face of that litigation. Sometime later, in two days of mediation, the plaintiffs received $23 million in settlements. Bill’s reputation as a foodborne illness go-to lawyer was cemented. Now, he said, there is not a significant outbreak of foodborne illness that isn’t touched by his firm.

In 1998 Marler Clark was formed, initially with four lawyers and four staff, now with six lawyers.

Bill is an enthusiastic, charming, ebullient, charismatic speaker. I wish we could have spoken for another hour or two. He was in Houston, speaking to a conference of food safety agencies. His schedule a week before and after our conversation took him all over America as a lawyer, speaker and advocate for food safety.  His next stop was Utah where he is representing a group of victims of food poisoning from a store’s chicken salad, including a 20-year-old woman who became brain injured, unable to work and unable to bear children as the result of the poisoning.

Bill indicated that the foodborne illness litigation is a small community of plaintiff and defense specialists where collegiality and professionalism still reign. He would recommend becoming a lawyer (he has a daughter who plans to take the LSAT) if you go in with your eyes open. Ask yourself: What do you want to do in your career? Can you afford to get a law degree?

Describing his life, he says, “I travel all over the world trying to convince companies that it’s a really bad idea to poison people.”

Not a bad goal to have. Not a bad way to spend a professional life.

Screen Shot 2017-06-18 at 8.59.17 AMIn the last two months, in between legal work that has taken me from Hawaii, Salt Lake City and Portland, Maine, I have had the honor to speak on food safety at the following venues:

Food Safety Summit – Chicago

Michigan State University – Lansing

Missouri Food Safety Task Force – St. Louis

Institute of Food Technologists – Sun Valley

Harris County Health Department – Houston

Later this week I am heading to New Zealand to a food security conference and then back to Florida for the International Association for Food Protection.

PrisonI can hear a bit of silence in the board rooms of America.

Monday the U.S. Supreme Court declined to hear the appeals of Austin “Jack” DeCoster and his son, Peter DeCoster, without comment.  In April 2015 U.S. District Judge Mark Bennett sentenced the DeCosters to prison, saying they knew or should have known about the risks posed by the presence of Salmonella in and around millions of egg-laying hens. However, he allowed the DeCosters to stay free while they appealed the sentences, which they argued were unconstitutional and unreasonably harsh. The 8th Circuit Court of Appeals upheld the sentences last July and stayed any action until the U.S. Supreme Court appeal was resolved.

Now the DeCosters will now both face three month jail sentences stemming from a Salmonella outbreak caused by their Iowa egg farms in 2010.

The Salmonella outbreak ran from May 1 to Nov. 30, 2010, and prompted the recall of more than a half-billion shell eggs, the largest recall of its kind in history. And, while there were 1,939 confirmed infections, statistical models used to account for Salmonella illnesses in the U.S. suggest that the eggs may have sickened more than 62,000 people.

The family business, known as Quality Egg LLC, had already pleaded guilty to the federal felony count of bribing a USDA egg inspector and to two misdemeanors associated with the outbreak. It agreed that the LLC will pay a $6.8-million fine and the DeCosters would be fined $100,000 each, for a total of $7 million.

I am not sure if the Supreme Court read Bill Neuman’s New York Times article from September 2010 entitled, “An Iowa Egg Farmer and a History of Salmonella.” However, he should. Here are some of the highlights/lowlights:

  • DeCoster’s frequent run-ins with regulators over labor, environmental and immigrationviolations have been well cataloged. But the close connections between DeCoster’s egg empire and the spread of Salmonella in the United States have received far less scrutiny.
  • Farms tied to DeCoster were a primary source of Salmonella enteritidisin the U.S. in the 1980s, when some of the first major outbreaks of human illness from the bacteria in eggs occurred, according to health officials and public records. At one point, New York and Maryland regulators believed DeCoster eggs were such a threat that they banned sales of the eggs in their states. “When we were in the thick of it, the name that came up again and again was DeCoster Egg Farms,” said Paul A. Blake, who was head of the Enteric Diseases Division at the Centers for Disease Control and Prevention in the 1980s, when investigators began to tackle the emerging problem of Salmonella and eggs.
  • Records released by Congressional investigatorslast week suggest that tougher oversight of Mr. DeCoster’s Iowa operations might have prevented the outbreak, which federal officials say is the largest of its type in the nation’s history, with more than 1,600 reported illnesses and probably tens of thousands more that have gone unreported.
  • According to the records, Mr. DeCoster’s farms in Iowa conducted tests from 2008 to 2010 that repeatedly showed strong indicators of possible toxic salmonella contamination in his barns. Such environmental contamination does not always spread to the eggs, and it is unclear what actions Mr. DeCoster took in response. However, when the Food and Drug Administrationinspected the farms after the recalls, officials found unsanitary conditions and the presence of Salmonella enteritidis in barns and feed.
  • The first enteritidis outbreak recognized by public health officials came in July 1982, when about three dozen people fell ill and one person died at the Edgewood Manor nursing home in Portsmouth, N.H. Investigators concluded that runny scrambled eggs served at a Saturday breakfast were to blame. They traced the eggs to what the Centers for Disease Control reports referred to as a large producer in Maine; interviews with investigators confirmed that it was Mr. DeCoster’s former operation.  Eggs from the same farms were also suspected in a simultaneous outbreak that sickened some 400 people in Massachusetts.
  • In 1987, the deadly outbreak at Coler Memorial Hospital on Roosevelt Island occurred. Investigators determined that mayonnaise made from raw eggs had caused the outbreak. They traced the eggs to Mr. DeCoster’s Maryland farms. On a July night in 1987, scores of elderly and chronically ill patients at Bird S. Coler Memorial Hospital in New York City began to fall violently sick with food poisoningfrom eggs tainted with salmonella.  “It was like a war zone,” said Dr. Philippe Tassy, the doctor on call as the sickness started to rage through the hospital. By the time the outbreak ended more than two weeks later, nine people had died and about 500 people had become sick. It remains the deadliest outbreak in this country attributed to eggs infected with the bacteria known as Salmonella enteritidis.
  • After two more outbreaks were linked to DeCoster eggs the following year, New York banned Mr. DeCoster from selling eggs in the state. He was forced to agree to a rigorous program of salmonella testing on his farms in Maine and Maryland.  Michael Opitz, a poultry expert retired from the University of Maine, said that the testing found that a Maine breeder flock owned by Mr. DeCoster was infected, meaning that hens there could be passing the bacteria to their chicks, which might grow up to lay tainted eggs. Widespread contamination was also found in laying barns.
  • In 1991, tests revealed more salmonella contamination at one of Mr. DeCoster’s farms in Maryland. The state quarantined the eggs, allowing them to be sold only to a plant where they could be pasteurized to kill bacteria. Mr. DeCoster challenged the order and a federal judge ruled that Maryland could not block him from shipping eggs to other states. He was still barred from selling the eggs in Maryland, and in 1992, a state judge found that he had violated the quarantine by selling eggs to a local store; Mr. DeCoster was given a suspended sentence of probation and a token fine.
  • Soon after interstate shipments resumed in 1992, eggs from the Maryland farm caused a salmonella outbreak in Connecticut, according to a 1992 memo from the Maryland attorney general’s office. Federal regulators insisted that Mr. DeCoster decontaminate his barns.  Dr. Roger Olson, the former state veterinarian of Maryland, said that Mr. DeCoster complained about the cost of testing and the quarantine and insisted there was little risk associated with his eggs.

And, then there was 2010.  I think Jack and Peter need some time away to think about this.

fdc596fe48e3cfaef296ee83738e95a2Seattle/King County Public Health is investigating an outbreak of gastroenteritis with abdominal cramps and diarrhea associated with Rancho Bravo Tacos at 1001 East Pine St, Seattle. Four people from a single party became ill soon after eating food at the restaurant on 4/22/17; none were hospitalized. Symptoms and timing of illness onset are suggestive of a bacterial toxin from Bacillus cereus or Clostridium perfringens. No tests were done to confirm which pathogen caused the illness: bacterial toxin illnesses are typically short-lived and by the time people seek care – if they do at all – it is too far from exposure to test.

Public Health received the report of illnesses on 4/24/17 but has not received any other recent reports of illness associated with this restaurant. As part of the Public Health investigation, Environmental Health Investigators visited the restaurant on 4/25/17. During the field inspection, improper cooling and hot holding of potentially hazardous foods were identified, factors that may have contributed to this foodborne illness outbreak. Foods that were prepared over the weekend were discarded and improper food handling practices that were identified during the inspection were also corrected. The restaurant is working cooperatively with Public Health. A return visit will be conducted within 14 days to ensure that these corrected practices remain in place.

B. cereus and C. perfringens are both bacteria that grow rapidly at room temperature. When cooking potentially hazardous foods, it’s important to keep food out of the danger zone, which is 41 to 135 degrees Fahrenheit by serving while the food is still hot, placing hot food into shallow pans and directly into the refrigerator to cool food quickly, or holding at a minimum of 135 degrees.