Bill Marler, the E. coli lawyer, shot for Trial Magazine in Seattle, WA

Trial Magazine April 2018  – Bill Marler interview, by Kate Halloran

Attorney Bill Marler of Marler Clark in Seattle has dedicated his career to representing people injured by foodborne illness and to advocating for better food safety regulation. Trial spoke with him about what’s challenging about these cases, common misconceptions, and what more needs to be done to protect consumers.

How did you get started in food safety?

My first experience with food safety litigation was the 1993 Jack in the Box E. coli outbreak, which was linked to the fast-food chain’s meat. More than 700 people were sickened, with hundreds hospitalized—dozens with acute kidney failure—and four children died. It was one of the first major foodborne illness cases that happened in the United States.

A woman I had done some legal work for called me, and she asked if I would meet with a friend of hers whose kid was in the hospital with E. coli. I met with the family, and I filed the first lawsuit against Jack in the Box that week. I didn’t even know what E. coli was, frankly. I gathered information from the University of Washington’s medical school to get up to speed.

Very quickly, I went from having a handful of cases to being lead counsel for more than 400 cases that were filed in several states against the restaurant. By the time Jack in the Box started settling cases, I probably knew more about E. coli than one would ever want to. Shortly after that, there was an outbreak linked to unpasteurized juice sold by Odwalla, and I started working on those cases. After that, I decided to start my own firm, and I hired Bruce Clark, who had been chief counsel for Jack in the Box. Now all we do is handle food cases nationwide.

What are some of the most significant changes you’ve seen resulting from food safety litigation?

I think that, like a lot of lawyers who do products cases, the hope is that litigation leads to structural changes in whatever industry you’re going after, and I think for the most part it does. From the 1990s to early 2000s, most of our work involved E. coli cases linked to hamburger; now that is nearly zero. The positive changes—more testing, more interventions to prevent contamination—have led to a safer meat supply.

But I became frustrated by the pace of change, so I started doing more advocacy work. I started speaking to consumer, public health, and industry groups. And by then, unfortunately, I had a lot of stories about severely injured children, pregnant women, and elderly adults and how devastating foodborne illness can be.

I became very involved with the political side of food safety, including the run-up to the Food Safety Modernization Act, which was signed by President Obama in 2011. It established a variety of new regulations for food manufacturers and importers to ensure product safety through controls, testing, and sanctions. That law was a multiyear effort by consumer and industry groups, lawyers, and clients who testified in front of Congress.

I also have seen a lot of changes in how the U.S. Department of Agriculture (USDA) regulates food, primarily meat. And that is due to a combination of litigation and regulatory pressure—making companies do the right thing, whether for economic or moral reasons.

With the FDA, which regulates most of our food supply, we’re starting to see some positive impact from recent regulations that cast a wide net over all FDA-regulated products to ensure that they are manufactured to enforceable standards that are likely to reduce foodborne illnesses. We’ve seen a downturn in salmonella and E. coli cases linked to leafy greens, which were common 10 years ago.

What food safety issues are you seeing become more common?

Imports are becoming a bigger part of my cases—not necessarily because imported food products are inherently dangerous, but because the increase in the volume of imported food means that more tainted food cases are coming from imports. That creates additional legal challenges because you can’t necessarily sue a supplier or manufacturer in China. There are some real opportunities for regulation to help. We still can hold importers and retailers responsible for contaminated food from overseas.

And we’re seeing outbreaks happening with unexpected foods. For example, we’re representing people who were sickened by a soy nut butter E. coli outbreak, including an 11-year-old boy who was hospitalized for months in the ICU, lost his large intestine, suffered severe brain and kidney injuries, and is learning how to walk again. These are significant and serious cases from a food product that you wouldn’t necessarily expect to cause injury.

What are the strengths and weaknesses of the consumer alert and recall process for contaminated food?

I’m a big fan of recalls and product testing that prompts recalls. Like litigation, testing and recalls are a market-driven exercise. Companies tend to try to find a way to fix a problem so they don’t have to spend money on it. We saw this during the mid-to-late ’90s when it was common to see hamburger recalls on a weekly basis because companies were testing their products and finding E. coli, so they had to recall them. Then, to prevent recall costs, they started testing and holding the product, so it wouldn’t even get into the marketplace; or they’d test it and divert it to be a cooked product to kill the bacteria. The number of E. coli cases from hamburger dropped like a stone.

But there are some odd delineations between USDA and FDA when it comes to food safety. USDA regulates meat, except fish (other than catfish). FDA regulates everything else—fruits, vegetables, and fish primarily, as well as baked goods and similar processed foods. The FDA rules are pretty clear: If food has a pathogen in it that can make you sick, then it’s an adulterated product. But for USDA, if chicken in a grocery store has salmonella on it, the agency may not consider it to be adulterated until the chicken can be proven as the source of an illness—then that would prompt a recall. And there are some recall rules that relate to E. coli but not salmonella—even though both make people sick.

But one thing that USDA does when there’s a recall is tell you the entire chain of distribution—who produced the item and where it went. The FDA does not. When the FDA recalls something, it names the manufacturer, but it doesn’t tell you where the products went. The soy nut butter product I mentioned before was recalled in March 2017, but we’re still finding it for sale online and in grocery stores. To me, that’s a real failing of the FDA not to look at the system from manufacturer through where people buy the product and make the public aware of what’s going on.

As the local food movement and farmers’ markets have become popular, has that changed where you’re seeing problems in the food supply?

That’s a difficult question to answer. The reason why is that most people who get a foodborne illness never figure out what made them sick. Even when there are clusters of ill people, they seldom link it to a particular food item, restaurant, or manufacturer. It is very difficult, and it’s what we spend most of our time figuring out. We figure out causation, and then we can do something. But we turn away 90 percent of prospective cases because causation is unclear.

That helps explain part of the issue with local or regional outbreaks. Multistate outbreaks are much easier to put together because then you can pinpoint common denominators among people. The farther apart people are, the more likely it is you’ll be able to find a common thread. But with just a couple of people in the same city, it may be too difficult to untangle the common denominator—or there may not be enough data available to make that determination.

Because the incubation period of different bacteria can vary from hours to weeks, the smaller the operation, sometimes the more difficult it may be to pinpoint the food item that made someone sick. And that’s important­ because if you looked at it, you’d say, “Clearly local agriculture’s not poisoning anybody.” But that would be a false assumption. It’s most likely that it is but on a smaller scale and so the statistics don’t necessarily implicate it. Bacteria don’t care whether you’re a big producer or a small producer—they’ll sicken your customers regardless. That’s why good food handling and manufacturing practices are essential.

What are some of the risk factors for foodborne illness outbreaks?

When you delve into it, you still see companies that have bad manufacturing processes and practices. A lot of it has to do with cooking and cleanliness. A product that’s not cooked is a bigger risk than a product that’s cooked because most bacteria and viruses are killed by cooking. If you have a product that’s heated well, it’s unlikely that you’ll have a foodborne illness outbreak.

Foods that are eaten raw and don’t have what’s called a “kill step,” such as lettuce, can be a riskier food item to the consumer. That’s why certain kinds of cheeses and deli meats—foods that are consumed without cooking them again—shouldn’t be eaten by certain groups, such as pregnant women, because there’s a risk of listeria. Unpasteurized juices, unpasteurized milk, oysters—foods that are close to the environment where contamination can occur and then are eaten raw tend to be more risky.

That’s why fresh fruits and vegetables, while important for human consumption, need to be washed and handled properly. You may not necessarily rid the food product of all contaminants, but you’re knocking down the bacterial load to the point that your body can handle it. If you consume 10 E. coli bacteria, it’s likely that your body will be able to ignore it. But if you ingest 100 bacteria, that might be enough to overwhelm your system and make you sick—and in some instances, really sick.

A lot of foodborne illness tends to have worse effects on the elderly, children, immune-compromised people, and pregnant women. Unfortunately, if you look at the size of the vulnerable population, it’s a big chunk of America. These people are the most vulnerable to becoming ill and the ones most likely to have severe reactions—kidney failure, long-term complications, or death.

What is the biggest challenge when helping clients in different states seek recovery for injuries from a foodborne illness outbreak?

I often deal with cases following an outbreak in different states that may have the same liability and causation law, but they have differences in damages law. I remember a listeriosis case when we represented 30 people and families of people who died from eating cantaloupe, and they were in 15 different states. A person in Oklahoma’s damages were capped at $150,000, while for pretty much the same person in Montana, there was no cap—and so the damages would be much more. Even in cases with severe injuries, state legislatures limit legitimate compensation for people, and it’s obviously unfair.

People can be exposed to some of the same bacteria that cause foodborne illness through environmental contamination, such as at a water park or other public recreation area. What are typical issues in these cases?

In food cases, it’s a product that you’re consuming that causes the illness, so you’re dealing with strict liability laws, which most states have. Once you’re able to prove that the product caused the injury, it’s really game over and becomes about damages. In environmental contamination, such as at water parks, swimming holes, or petting zoos, that falls in the negligence category. Whether it is a petting zoo that didn’t have adequate handwashing stations to reduce the risk of transmitting bacteria from the animals or a water park that wasn’t chlorinating or filtering the water appropriately, you need to find some act of negligence that caused the outbreak. That tends to be a much larger but not insurmountable challenge.

What are the most common misunderstandings you see about foodborne illness?

The biggest misunderstanding in food cases is the science behind incubation periods. Everyone’s convinced it was the last thing that they ate. It may well be something you ate two or three days ago. For example, I get a lot of calls from both victims and lawyers who say they or their client ate here and an hour later got sick with E. coli. Well, that isn’t the case because the incubation period between the time of ingestion and first symptoms is three to four days.

When evaluating a case, it’s always important to find out if the potential client had medical treatment and whether a stool culture or blood culture was done so you know what bacteria it is and have a fairly good understanding of what the time frame is—you’re looking for a common denominator. Figuring out what caused the illness is one of the major challenges.

The other big misunderstanding for consumers and even more so for businesses is that some of these cases can lead to devastating injuries. I’m representing a 19-year-old girl who has her whole life ahead of her, and she ate chicken salad that was tainted with E. coli. She spent four months in the hospital, had her large intestine removed, suffered multiple seizures, and her kidneys failed. Fortunately, she was able to get a kidney transplant—but kidneys last 10 to 15 years, and then you need another transplant. People don’t realize that foodborne illness can cause such severe, life-changing injuries.

Here is the link to the “200 Million Eggs Recalled Over Salmonella Concerns”

https://www.wnycstudios.org/story/food-recalls-and-federal-oversight

In one of the largest-ever recalls of eggs, Rose Acre Farms ordered 206 million eggs off of consumer shelves after health officials traced a salmonella outbreak to one of its farms in North Carolina. The product is the second major recall this year, with a separate warning out to consumers of romaine lettuce because of E. coli that has spread across seven states.

This year is the 25th anniversary of the “Jack in the Box” E. coli outbreak that spread across 73 stores, sickening over 700 people and contributing to four deaths. That outbreak changed how the U.S.D.A. and F.D.A. monitor food safety today and is part of the reason why the recent recalls of eggs and packaged lettuce can be seen as signs of regulatory success.

Ben Chapman, associate professor at North Carolina State University and co-host of the Food Safety Talk podcast, and Bill Marler, attorney specializing in food-borne illness, discuss the latest recall in the context of broader regulatory trends within the federal government.

 

Over the last 20 plus years I have given countless talks to food industry groups on the moral and business reasons to “not poison your customers.”  However, it has only been a handful of companies who have allowed me behind the curtain (at no charge) to talk directly, candidly and forcefully about the role of litigation as a agent of change in our food system.  Today, I had the honor to talk with the leaders at Walmart whose jobs it is to protect their customers around the world from the ravages of E. coli, Salmonella, Listeria and Hepatitis A.

A commitment to a culture dedicated to safe food lessens the chances of a food poisoning event, litigation and brand damage – all under the watchful gaze of Mr. Walton.

Food poisoning meets economics in this episode of the Food Chain. And it’s a toxic mix.

We’ll explore how an outbreak can bring down a company, badly damage an industry and shine a light on social and economicinequalities and our globalising food system. Emily Thomas talks to a top food poisoning lawyer in the US, who has won more than $600 million for clients in foodborne-illness cases. And a former banker explains why a dodgy sandwich inspired him to quit his day job for the cause. Plus, how do you prove where you got food poisoning from and what can you do to avoid it?

Listen here – https://www.bbc.co.uk/programmes/w3cswpm7 

My friends at CIDRAP did a great job of pouring over the recent FoodNet report (Mar 23 MMWR report) on the incidence of a variety of pathogens.  I will steal a bit from their work.

Good news: Salmonella Typhimurium and Heidelberg illnesses down which mirrors decrease in positives in chicken and a decreased incidence of hemolytic uremic syndrome from 2006 to 2016 which mirrors an STEC O157 decline in ground beef over the same timeframe.

A team from the US Centers for Disease Control and Prevention (CDC) and partners in 10 states that are part of the FoodNet surveillance network reported its findings today in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

The group publishes an annual FoodNet report in early spring, and this year’s report sums up lab-confirmed infections from nine pathogens for 2017, detailing changes since 2006. The pathogens are Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E coli (STEC), Shigella, Vibrio, and Yersinia.

For 2017, the FoodNet system identified 24,484 foodborne illnesses, 5,677 hospitalizations, and 122 deaths. Highest incidences per 100,000 population were for CampylobacterSalmonella, and Shigella.

Growing use of culture-independent diagnostic tests (CIDTs) at public health labs is a useful tool for quickly identifying illnesses that might be missed by other lab tests, leading to more accurate incidence estimates, the authors write. They note, however, that their use can complicate the interpretation of estimates and that culturing isolates is still needed to reveal subtype information and test for antimicrobial susceptibility.

Regarding the infections only found on CIDT testing, percentages were highest for Yersinia (51%), Campylobacter (36%), Shigella (31%), Vibrio (29%), STEC (27%), Salmonella (9%), and Listeria (1%). Compared with findings from 2014 to 2016, incidence for 2017 was significantly higher for CyclosporaYersiniaVibrio, STEC, Listeria, and Campylobacter.

Given that the use of CIDT panels are rising, tests more often routinely detect CyclosporaYersiniaVibrio, and non-O157 STEC, the group said. “The increased incidence of these infections in 2017 was most likely driven by the increased use of CIDTs,” they wrote.

Of subtyped Salmonella isolates in 2017, the five most common were Enteritidis, Typhimurium, Newport, Javiana, and I 4,[5],12:i:-, a variant of Typhimurium. For 2017, the incidence of Heidelberg was 65% lower than from 2006 to 2008, with a similar decrease for Typhimurium over the same period.

When the scientists looked at STEC isolates, they found that the incidence of non-O157 STEC increased significantly in 2017 compared with 2014 to 2016. Though O157 STEC held steady, the incidence decreased 35% compared with 2006 to 2008.

In its continued efforts to protect consumers and ensure food safety, the U.S. Food and Drug Administration has begun testing fresh cilantro, parsley and basil, as well as processed avocado and guacamole, for certain microbial contaminants. These two large-scale sampling assignments will help the FDA assess the rates of bacterial contamination in these commodities, as well as help to identify possible common factors among the positive samples.

The FDA plans to collect 1,600 samples for each assignment. As of January 1, 2018, the agency had collected 35 domestic samples (4.6 percent) and 104 import samples (12.4 percent) of the total for fresh herbs. None of the domestic samples tested positive. Of the 104 import samples tested, 4 tested positive for Salmonella, 3 tested positive for Shiga toxin-producing E. coli, and none tested positive for E. coli 0157:H7.

As of January 1, 2018, the agency had collected 58 domestic samples (7.3 percent) and 49 import samples (6.1 percent) of the totals for processed avocado/guacamole. Of the 58 domestic samples tested, 3 tested positive for Listeria monocytogenes. Of the 49 imported samples, 1 tested positive for Listeria monocytogenes. It is important to note that no conclusions about overall contamination rates can be made until all of the data are collected, validated and analyzed.

If samples are found to be positive for microbial hazards, the FDA will pursue an appropriate regulatory and enforcement option, which may include encouraging a voluntary recall, ordering a mandatory recall, ordering administrative detention to prevent food from being distributed, issuing public warnings to alert consumers to the potential danger, or, in the case of imported products, refusing their entry into the United States and subjecting future shipments to an import alert. In the case of the positive samples identified in the first quarter of data collection, imported products capable of causing disease were prevented from entry into the United States and domestic products were voluntarily recalled.

The agency chose to sample fresh herbs because they are typically eaten without having undergone a ‘kill step,’ such as cooking, to reduce or eliminate bacteria. These herbs are also often eaten as part of multi-ingredient foods, and thus people may not report having eaten them when they become ill.

From 1996 to 2015, the FDA reported nine foodborne outbreaks linked to basil, parsley and cilantro, which resulted in 2,699 illnesses and 84 hospitalizations. Of the nine outbreaks, seven were attributed to Cyclospora cayetanensis; one was attributed to E. coli O157:H7; and one was attributed to Shigella sonnei. The FDA is seeking to obtain baseline estimates of the prevalence of Salmonella and Shiga toxin-producing E. coli (STEC) in cilantro, basil and parsley. The agency also intends to test for Cyclospora cayetanensis during the summer months, when  Cyclospora-related illnesses typically occur.

The agency chose to sample processed avocado because avocados have a high moisture content and a non-acidic pH level, conditions that can support the growth of harmful bacteria. Processed avocado products, including avocado that is fresh cut, refrigerated and frozen, may be packaged and eaten without having undergone a ‘kill step’ prior to consumption. According to the Centers for Disease Control and Prevention, there were 12 outbreaks of foodborne illness related to avocado, avocado products or guacamole products from 2005 to 2015. Of those 12 outbreaks, nine involved Salmonella and three involved E. coli, resulting in 525 illnesses and 23 hospitalizations. Though no Listeria outbreaks were reported in connection with avocados from 2005 to 2015, a recent sampling assignment by the FDA detected Listeria monocytogenes in samples collected from the fruit’s pulp and skin. The agency is seeking data on the prevalence of Salmonella and Listeria monocytogenes in processed avocado and processed avocado products.

The  assignments are anticipated to last 18 months. The agency will post results on a quarterly basis and also post a comprehensive report once sampling and analysis is complete.

 

My friend, Darin Detwiler, let me post this tonight for tomorrow.

Today marks the 25th anniversary of the day the last of four young children died during the landmark 1993 “Jack in the Box” E. coli outbreak

That child was 17-month-old Riley Edward Detwiler.

I learned about the reality of this foodborne pathogen on Riley’s death bed.  When he was only a few months old, I justified being out to sea on a Navy submarine by telling myself that I was making the world a safer place for him, and I thought that I would spend the rest of my life making up lost time with him when he was older.

Riley would now be older than I was during that outbreak.  I never got to see him grow older than he appeared in the few photos and videos from so long ago.  Over the years since his death, however, I have seen news of recalls and outbreaks and deaths on a far too regular basis.  I have also seen much improvement in food safety.

We have gained new federal food safety regulations and policies at the USDA and, most recently at the FDA.  We have witnessed advancements in science and data collection, and even a whole new “culture of food safety.” We have trainings, certifications, university programs, conferences, magazines, books, and even movies that serve to inform and motivate new generations of food safety experts.

Many of the changes in food safety policies came about through the hard work of victims, families, advocacy groups, and industry leaders. Statistics and charts alone achieve little without victim’s voices.  Facts rarely motivate policymakers as much as seeing the faces and stories. I am very proud of their efforts.  I am also proud to have stood with them and before them trying to prevent other parents from looking at their family table with one chair forever empty due to preventable illnesses and deaths from foodborne pathogens.

One thing that hits me hard lately is how the faces and stories of victims from mass shootings are seemingly not enough to bring about change in terms of gun control.  While no new policies will bring back the dead, they would bring hope and an increased safety for others.  I am saddened by the thought that so many parents will live with the belief that their child’s death did not result in some element of change.

Perhaps the reasons matter not as to why parents worry about making the world a safer place for their children.  Too many homes in this country include a chair forever empty at a family table due to reasons that could and should have been prevented.

Dr. Darin Detwiler is the Assistant Dean, the Lead Faculty of the MS in Regulatory Affairs of Food and Food Industry, and Professor of Food Policy at Northeastern University in Boston.  In addition to serving as the executive vice president for public health at the International Food Authenticity Assurance Organization, he is the founder and president of Detwiler Consulting Group, LLC. Detwiler and serves on numerous committees and advisory panels related to food science, nutrition, fraud, and policy. He is a sought-after speaker on key issues in food policy at corporate and regulatory training events, as well as national and international events. Detwiler holds a doctorate of Law and Policy.

The new mother,Michelle Carr, of a 10-week-old newborn boy was enjoying a quick lunch on Jan. 29 as she washed her lettuce, inverted it to drain, ripped it apart by hand and threw on some grape tomatoes, olive oil and balsamic vinegar. Then, as she went to take a bite, she stuck her fork into something firm, but it wasn’t a slice of avocado.

It was the scaly, tail-less carcass of a lizard.

“It was longer than my middle finger without its tail. We’re not talking about a spider or a bug or even a little salamander. This was a huge lizard with scales,” said Carr, a registered hematology oncology bone marrow transplant nurse. “I instantly wretched and I was revolted because I thought for a second I could’ve eaten its tail.”

Carr said she purchased the bag of store-brand romaine lettuce at the Shaw’s supermarket in Portsmouth on Jan. 26.

Carr said she had a friend who is a biologist examine the lizard and told her it could have been a blue-bellied lizard, which primarily live in California and can be up to 8.4 inches long, according to the Burke Museum at the University of Washington. The lettuce is distributed by a company out of California.

Carr said she then called representatives at the New Hampshire Department of Health and Human Services (NHDHHS), Shaw’s and the Food and Drug Administration but had not yet heard if her complaint was being investigated.

On Monday, NHDHHS communications director Jake Leon took a call from Seacoast Media Group and confirmed his agency had received the complaint from Carr. Because the lettuce was packaged and shipped from another state, he said that any investigation would be conducted by the FDA.

Today interviewed me earlier in the week on the food I tend to avoid and why:

The alarming food recalls keep coming: Romaine lettucepackaged vegetableschickenfrozen fruitcheesespotato chips and many more products in just the last couple of years. All were feared to be contaminated by harmful bacteria.

Bill Marler knows all too well what kind of damage tainted food can do. The Seattle attorney has represented victims of foodborne illness for 25 years — people who came close to death just by eating a hamburger. Marler’s work hasn’t put him off from eating in restaurants, but he’s more wary when he eats out.

“If I had a rule that I follow, it’s that I eat things that are well-cooked or that are cold, because bacteria tend to not do well at hot temperatures and tend to not grow at cold temperatures,” Marler told TODAY.

“There’s just some good common sense when you’re not controlling the food you consume.”

Each year, 48 million Americans get sick from foodborne diseases and 3,000 die, the CDC estimates. It names norovirus, salmonella and clostridium perfringens as the top three illness-causing germs. Bugs that are more likely to lead to hospital stays include botulism, listeria and E. coli. E. coli cases linked to red meat are down, but Marler has been alarmed by an increase in cases of listeria, which — unlike most bacteria — can grow at refrigerator temperatures.

Based on the cases he’s been involved in, Marler has come up with a list of seven foods he never eats:

1. Raw sprouts

All types of raw sprouts, including alfalfa, mung bean, clover and radish sprouts, are at the top of Marler’s list.

“Sprouts are just a really difficult product to make safe,” he said. “Seeds get contaminated and then when you sprout things in warm water, it’s a perfect bath for the bacteria to grow.”

The Barf Blog, a website run by a former professor of food safety, has documented at least 55 sprout-associated outbreaks — or “sprout-breaks,” as Marler calls them — worldwide since 1988. Most have been caused by salmonella and E. coli.

The latest suspected outbreak has sickened eight people with salmonella in Illinois, Wisconsin and Minnesota since December, with raw sprouts served at Jimmy John’s restaurants “a likely source,” the CDC reports. The Illinois Department of Public Health asked the restaurant chain to remove sprouts from their menus until the investigation is complete.

Sprouts should be cooked thoroughly to reduce your risk of illness, the government advises. Children, the elderly, pregnant women, and people with weakened immune systems should avoid eating any raw sprouts, it notes.

2. “Raw” milk and juices

Whatever possible benefit you think you might get from unpasteurized milk or “raw” packaged juice, it’s not worth the risk, said Marler, who helped create a website listing some of the consequences of people drinking contaminated raw milk, including kidney failure and paralysis.

Raw milk and products made from it can contain bacteria, viruses, and parasites that pose “severe health risks, including death,” the CDC warns. Possible germs include campylobacter, E. coli, salmonella and listeria, with 81 outbreaks in 26 states linked to raw milk from 2007-2012, the agency notes.

As for raw juice, if you’re making it at home in a clean environment, washing the exterior of the fruit, and then drinking the juice right away, the risks are very low, Marler said. Just skip any packaged “raw” juice.

Marler would also stay away from “raw” water: “It’s sometimes amazing to me how we humans forget our history,” he said. “You just sort of scratch your head and wonder what people are thinking.”

3. Raw flour

Raw flour has been linked to E. coli outbreaks, so resist the temptation to eat cookie dough or taste raw cake batter.

“It’s something I think the public is pretty unaware of and we need to educate people that when handling flour you buy in the bags in the grocery store, you have to consider it a raw agricultural product that could be the source of a pathogen,” Marler said.

People often dust their kitchen counter top with flour when rolling out dough. Think about it this way: it’s not dissimilar to putting raw chicken on your counter, so wipe things down and consider using wax paper instead, he advised.

4. Pre-cut fruits and vegetables

The more you control food in your own kitchen, the less likely it is to be a problem, Marler believes. He finds it much safer to take your own apple, wash it, cut it and put it in a plastic bag for lunch than to go to the grocery store and buy an apple that was sliced a few days ago in facility 500 miles away.

“It’s certainly convenient, but sometimes I think the convenience isn’t worth the risk,” he said. “I don’t buy pre-washed, pre-bagged products, but if I did, I would wash it again myself. It’s all about decreasing the bacterial load.”

5. Ground meat that’s not well done

Any ground meat has to be cooked thoroughly, Marler said. That’s because bacteria on the surface of the meat can get mixed throughout the product when it’s ground. Be sure to cook ground beef, veal, pork and lamb to an internal temperature of 160°F, the CDC notes.

When it comes to a whole piece of beef steak, like filet mignon, Marler would consider eating it medium or medium-well done. But chicken, turkey and other poultry has to be cooked thoroughly, he noted. The CDC recommends cooking it to an internal temperature of 165°F.

In case you’re wondering, Marler isn’t that concerned about raw fish, but he still doesn’t eat a lot of sushi.

6. Raw oysters

Marler has seen a spike in bacterial and viral illnesses linked to raw oysters in the last several years, perhaps because the water is warmer for longer periods of time, he said. Eating raw oysters is not worth the risk, he added.

7. Raw eggs

They’re still on Marler’s list, although government oversight and industry intervention have made eggs a lot safer today than they were a decade ago, he said.

But even though the likelihood of salmonella has “decreased a lot,” he still wouldn’t eat eggs raw (even from the chickens he raises at home), sunny-side-up or soft-boiled, especially in a restaurant. He always opts for scrambled eggs.

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Tony Turnbull of the Times dropped this headscratcher on us the morning: “Cooking with your Mouth:  Why using a knife for chopping your carrots is so last year.” Like the story of drinking – very expensive – “raw water,” eating food that has been prepared in someone elses mouth sounds a bit more likely coming from the Onion, than the more conventional media.  And, as he pointed out deeper in the story, the video of the “cook” was in fact a spoof.

But in case you are wondering why it might have been a bad idea in any event, here is a bit on what can come from ones mouth to yours:

Infectious diseases can be spread through saliva or shared foods and drinks. When a person accidentally consumes microbe-contaminated items, such as saliva, the swallowing action of the tongue wipes the microbes against the back of the throat, allowing the microbe to enter the body. Infections, such as mononucleosis, caused by Epstein-Barr virus and cytomegalovirus are examples of infections spread via oral transmission from virus-containing saliva. Other infectious microbes that spread through saliva do so by sticking to the inner surface of the cheeks and mouth, the tongue, or teeth. An example is the bacterium Streptococcus, which can cause an array of infections, including gum disease strep throat. As a result, microbes that are found in the saliva can generally be found in other parts of the respiratory tract, including the nose and throat. Therefore, even colds and flu (and other respiratory infections) can potentially be spread through the saliva. Certain other infections causing ulcerations in the mouth can also be spread through saliva, such as cold sores (herpes virus) and hand, foot and mouth disease.