Safe Food: The Politics of Food Safety (8 page)

ISSUES AND ORIGINS

IN THE EARLY 1970S, A TIME WHEN FOOD SAFETY WAS BECOMING
a matter of public debate, my young family went to a dinner hosted by a colleague. I don’t remember much about the party, but its aftermath remains vivid. Within hours, all but one of us became violently ill. I will spare the details, as nearly everyone has had a similar experience. A flurry of telephone calls the next day made it clear that we were not the only ones who suffered after that dinner. In retrospect, what seems most remarkable about that event was how
ordinary
it was. We survived. We felt better in a day or two. We did not report our illness to health authorities, and neither did anyone else. We did not try to trace the source of the outbreak (although our one son who did not become ill, and who ate nothing green in those days, insisted that the salad must have been at fault).

We assumed that minor food poisonings were a normal part of daily living; they were low on our dread-and-outrage scale. It did not occur to us that microbial illness transmitted by food might be anything more serious than a minor inconvenience and a mess to clean up. If we gave any thought to cholera, typhoid, or botulism (let alone anthrax), we viewed them as diseases of the past, eliminated by basic public health measures such as water chlorination, milk pasteurization, or canning at appropriate temperatures. We were quite unaware of the emerging bacterial pathogens that I discuss in these chapters. At the time, if we worried at all about food safety, it was about agricultural pesticides or food additives—the chemical colors, flavors, and preservatives then increasingly
used to make processed foods look and taste better. We were not alone in worrying about food additives: a 1979 report recommended a complete revision of the food safety laws to strengthen our ability to control the use of food chemicals such as saccharin, the artificial sweetener that had just been linked to cancer risk.
¹

Additives and pesticides remained primary public safety concerns through the mid-1980s. Dr. David Kessler, who later became commissioner of the Food and Drug Administration (FDA), said that food safety laws needed an overhaul to control food additives—without even mentioning microbial hazards. Surveys of public attitudes toward food safety often asked about additives and pesticides but rarely probed knowledge or opinions about bacterial pathogens. When the surveys did include such questions, most people continued to rank additives and pesticides first among food safety concerns. At the time, less than 1% of food samples contained chemical additives and pesticides at “unacceptable” levels. Even if such levels were still too high—and any level of pesticides in food continues to raise safety questions—harm from food chemicals paled in comparison to that caused by pathogens. In the late 1980s, health officials found
Salmonella
in one-third of all poultry and estimated that 33 million Americans experienced at least one episode of foodborne microbial illness each year.
²

A few farsighted advocacy groups such as the Community Nutrition Institute in Washington, DC, pressed for more action to prevent pathogens from entering the food supply. They were aware of the emergence in the early 1980s of an especially nasty variant of
Escherichia coli
(
E. coli
), usually a relatively harmless inhabitant of the human digestive tract. As reports of toxic pathogens in food became more frequent, food safety priorities began to shift. By 1989, both
Time
and
Newsweek
had published cover stories on microbial food hazards. In 1991, the Center for Science in the Public Interest (CSPI), which had led public debate about food additives, published a consumer guide to food safety with exceptionally clear instructions about what needed to be done to prevent foodborne infections.
³

In the early 1990s, such publicity encouraged Congress to introduce more than 30 bills—a record number—related to food safety, and at least eight states were trying to develop their own rules. Ellen Haas, then president of the consumer advocacy group Public Voice, called food safety “not just a kitchen issue anymore.”
⁴
At the time, federal officials ranked microbial hazards first among food safety issues, residues of animal drugs second, and new technologies (such as genetically modified
foods) third. By 1994, more than 60% of consumers said they worried most about consuming rare beef, raw shellfish, and residues of animal drugs. In 1997, consumers and food editors said they were more concerned about food safety than they had been just one year earlier, and nearly all of them blamed meat and poultry producers—and government agencies—for not doing enough to prevent microbial pathogens in the food supply.
⁵

To establish a basis for understanding the significance of such a profound shift in attitudes, this chapter begins with an introduction to the current status of microbial pathogens in the food supply. We will see that foodborne illness is more than a biological problem; it is strongly affected by the interests of stakeholders in the food system—the food industry, government (agencies, Congress, and the White House), and consumers. The present system of food safety oversight and its political implications are best understood in historical context. Thus, this chapter describes the origins of the century-old policies that govern federal actions to this day. In the case of meat safety, Congress designed those policies to prevent sick animals—not microscopic pathogens—from entering the food supply. As this chapter explains, efforts to modernize such policies do not come easily.

Thinking too much about the life we share with microbes can lead to paranoia. Microbes are everywhere: around us, on us, and in us. They inhabit soil and water, skin and digestive tract, and any place that provides favorable conditions for growth (and hardly any place does not). They are incredibly small, and incredibly numerous. All kinds—viruses, bacteria, protozoa, and yeasts—are ubiquitous in raw foods. Most are harmless. Some are even “friendly,” helping to make bread, wine, vinegar, soy sauce, yogurt, and cheese, and keeping our digestive tracts healthy. Others are less helpful; left to their own devices, they rot apples, mold bread, and spoil meat. Some are decidedly unfriendly, and cause more than 200 known foodborne diseases.

To avoid getting food poisoning, we take precautions: we preserve foods and we cook them. Preservation methods—some ancient, some modern (among them salt, sugar, alcohol, acid, and freeze-drying)—all inhibit microbial growth. Refrigeration slows down growth, and freezing does so even more. Cooking, a brilliant invention, not only makes foods taste better but also kills microbial pathogens. Cooked foods, however, do not remain sterile. Microbes in air, water, and other foods can recontaminate them, as can microbes on packages, plates, utensils, cutting boards, and hands. With common measures such as hand washing, dish washing, and other such basic precautions, we live with most food microbes in relative peace. Our digestive and immune systems take care of those that survive cooking. Mostly, we do not worry much about them.

TABLE 3
. The most frequent microbial causes of foodborne disease in the United States: estimated numbers of illnesses, hospitalizations, and deaths, 1999

SOURCE
: Mead PS, Slutsker L, Dietz V, et al.
Emerging Infectious Diseases
1999;5:607–625.

NOTE
: Illnesses generally include some form of gastrointestinal distress—diarrhea, vomiting, cramps—as well as the problems indicated. These figures continue to constitute the basis of prevalence estimates.

Whether we
should
worry more about them is a matter of how we perceive risk. For most of us as individuals, an occasional episode of stomach upset—if not too severe—is tolerable. From a public health standpoint, however, the cost to society of such episodes is staggeringly high.
Table 3
lists, for example, the most frequent causes of foodborne disease, along with estimates of their cost in illness, hospitalization, and death. Viruses cause most foodborne illnesses, but some bacteria and protozoa are also to blame. Nearly all induce highly unpleasant symptoms, usually mild but sometimes very severe.
Table 3
, however, lists only the best-known pathogens. The causes of the vast majority of episodes of foodborne illness remain obscure.
⁶
Furthermore, pathogenic microbes pervade the food supply. A
Consumer Reports
investigation in 1998, for example, identified
Campylobacter
in 63% of market chickens,
Salmonella
in 16%, and both in 8%. Pathogenic
Salmonella
can pass from chickens to their eggs. Because egg production is so enormous, a low rate of infection—one out of every 10,000 eggs, for example—means 4.5 million infected eggs each year.
⁷

If harmful microbes are widespread in food and if they make so many people sick, why isn’t everyone—the food industry, health officials, and the public—doing something to prevent them from getting into food? One reason is that most episodes of food poisoning are not very serious. Another is that it is difficult to collect accurate information about the number of cases and their severity. Attributing a bout of diarrhea to food rather than to other causes is no simple matter. Most of us eat several foods at a time, several times a day, in several different places. How could we possibly know which food might be responsible for our getting sick, especially if there is a delay in the onset of symptoms? I cannot imagine bothering to call a doctor about a brief stomach upset. Even if I did, the doctor might not suspect food as the source of my problem. Busy doctors rarely report such suspicions to health authorities. It usually takes an “outbreak”—the severe illness or death of more than one person eating the same food—before health officials learn about a foodborne illness and attempt to trace its origin.

For these reasons, counting cases is a formidable undertaking, and to this day there is no national system for doing so. The current surveillance
system, such as it is, evolved piecemeal. In the 1920s, the Public Health Service started tracking diseases carried in milk. In 1961, the Centers for Disease Control (CDC), an agency of what is now the Department of Health and Human Services (DHHS), took over that task and began to issue annual counts of illnesses transmitted by food and drinking water. Five years later, the CDC initiated a
voluntary
program of state surveillance of outbreaks, meaning that states could choose whether or not to participate.

As early as 1970 the CDC realized that its counts were way too low. Nearly half the participating states were reporting no outbreaks or very few, suggesting considerable underreporting. In 1985, several federal and private agencies began to make more serious attempts to estimate annual cases of foodborne disease, based on two assumptions: (1) an episode of diarrhea counts as a foodborne illness, and (2) the proportion of reported cases to those that are not reported ranges from 1 out of 25 to 1 out of 100 or more. The agencies understood perfectly well that diarrheal diseases could be due to causes other than foodborne illness, and that foodborne illness also causes symptoms other than diarrhea. Nevertheless, they multiplied the number of cases of diarrhea by 25 to 100 to estimate the “real” number of cases. During the next few years, these confusing assumptions led to widely varying guesses about the number of annual cases (6.3 to 81 million) and deaths (500 to 9,000), depending on how the assumptions were interpreted.
⁸

In 1996, the CDC initiated a new surveillance program, FoodNet—the Foodborne Diseases Active Surveillance Network—in just a few states and for just seven microbial pathogens. In its first year, FoodNet identified 8,576 laboratory-confirmed cases of foodborne illness, of which 15% resulted in hospitalization. In 1999, the CDC used this and other information from its surveillance networks to suggest that
known
pathogens caused 14 million illnesses, 60,000 hospitalizations, and 1,800 annual deaths. When they added these estimates to those for cases caused by unknown pathogens, they arrived at the annual totals mentioned earlier: 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths.
⁹
Because these estimates rely so heavily on diarrheal symptoms, and the reporting system is voluntary, these figures almost certainly underestimate the extent of foodborne illness. A 1998 report on food safety from the Institute of Medicine (IOM) in Washington, DC, for example, gave a higher estimate. It assumed that adults in the United States average about 1.4 episodes of diarrhea every year, and that food is implicated in about one-quarter of those episodes; these assumptions yielded an estimate of 91 million cases per year.
¹⁰
Some experts suspect that even this number may be too low.
Such uncertainty means that reported trends in foodborne illness must be interpreted with caution. In 2002, FoodNet data suggested that cases of infection from four key pathogens had declined markedly since 1996, but cases caused by some strains of
Salmonella
had increased.
¹¹
Overall, the accuracy and significance of reported trends remain unclear.