jack_portrait_web.jpgWould the 1993 Jack in the Box E. coli outbreak ever have happened?

Over the last few weeks I have been I taking industry (well, Taco Bell) and government (well, CDC, FDA and eight states) to task for the failure to give up the name of mystery “Mexican-style fast food restaurant chain, Restaurant Chain A” as Taco Bell. However, not “naming names” is not a new, or frankly useful, phenomenon. In medical journal articles and in CDC publications over the years, the use of mystery “Restaurant A” is far more common that you would suppose.

Screen Shot 2012-02-08 at 3.47.41 PM.pngA Bit(e) of History:  In 1993, I was a young, ambulance chasing attorney (much thinner and with darker hair) who had his first big case in how the CDC described in 1993 as the “Multistate Outbreak of Escherichia coli O157:H7 Infections from Hamburgers — Western United States, 1992-1993” linked to “Restaurant A” (a.k.a. Jack in the Box). Although in medical publications the name of the restaurant to this day still remains a mystery, and the CDC in presentations still keep Jack in the witness protection program, public health officials and media in Washington State let Jack out of the box in 1993.

At the beginning of the Jack in the Box case, in researching E. coli O157:H7 and hemolytic uremic syndrome (HUS) – frankly, even learning how to say them – I headed to the University of Washington Medical School Library where I stumbled upon this article:

Ronald pics 070.jpgHemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med. 1983 Mar 24; 308 (12): 681-5. Riley LW, Remis RS, Helgerson SD, McGee HB, Wells JG, Davis BR, Hebert RJ, Olcott ES, Johnson LM, Hargrett NT, Blake PA, Cohen ML.

We investigated two outbreaks of an unusual gastrointestinal illness that affected at least 47 people in Oregon and Michigan in February through March and May through June 1982. The illness was characterized by severe crampy abdominal pain, initially watery diarrhea followed by grossly bloody diarrhea, and little or no fever. It was associated with eating at restaurants belonging to the same fast-food restaurant chain in Oregon (P less than 0.005) and Michigan (P = 0.0005). This report describes a clinically distinctive gastrointestinal illness associated with E. coli O157:H7, apparently transmitted by undercooked meat.

At first I thought “the same fast-food restaurant chain” must be Jack in the Box. I mean who else would poison kids in multiple states a decade apart? However, with a bit more digging, I learned that the 1982 undercooked burgers were Ronald’s not Jack’s.

So, what about transparency?  Medical journals and CDC publications become documents of record – they become history.  What if 1983 Jack in the Box knew that its chief competitor poisoned a bunch of kids?  Would Jack in the Box increased temperatures and cook times for its Jumbo Jack and avoided 1993?

Would they have denied my modest place in history?

If you hide the names, only those who know, know.  Yes, after 20 years of doing this, I can usually crack the code, but really, how useful is it to keep information like this secret from everyone else?