Dr. Mel Kramer | Food Safety News

Raw Poultry: Legal History, Public Policy, and Consumer Behavior

Dr. Mel Kramer — Fri, 14 Feb 2014 06:02:43 +0000

The U.S. Centers for Disease Control and Prevention (CDC) reported that, “as of January 15, 2014, a total of 430 persons infected with seven outbreak strains of Salmonella Heidelberg have been reported from 23 states and Puerto Rico.” In response to the news, the popular media, the technical and professional public health and consumer publications, including the blogosphere, have weighed in with opinions. The question is whether or not the poultry producer should have voluntary recalled the raw chicken, which, based on epidemiologic, laboratory, and traceback investigations conducted by local, state, and federal officials, indicated that “consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections.” This question is not only multi-faceted, but has a rich history from a public health, public policy and legal perspective dating back to the early 1970s. I feel in a somewhat unique position to write this since my superior at the New Jersey State Department of Health, Oscar J. Sussman, DVM, JD, MPH, was involved. He influenced the American Public Health Association (APHA) to formally sue the U.S. Department of Agriculture (USDA) for failure to warn the public that up to 50.8 percent of federally inspected poultry was positive for Salmonella.(1) Sussman wanted USDA to put a very simplistic warning on every retail package of poultry stating, “Caution. Improper cooking of this product may be hazardous to your health.” The warning was to counter the seal of inspection in which the USDA certifies that the poultry is “wholesome” because a pathogen such as Salmonella is not wholesome unless and until the poultry is properly thermalized to an internal temperature of 165 degrees F. This temperature will adequately kill all Salmonella and other pathogens present. The lawsuit was filed and adjudicated in the U.S. District Court for the District of Columbia. The issue of the litigation went in a slightly different direction challenging the Wholesome Meat Act and the Wholesome Poultry Products Act as contained in 21 U.S.C.S. § 601, et seq. and 21 U.S.C.S. § 41 et seq., respectively. In the initial case, which was ultimately appealed and decided on Dec. 19, 1974, by the U.S. Court of Appeals for the District of Columbia Circuit in the matter styled APHA v. Butz, the plaintiffs argued that the government’s official mark of inspection was misleading; therefore, the product was misbranded since USDA failed to warn against the dangers of Salmonella.(2) Although USDA tried to settle the case in exchange for consumer education, which they ultimately did, the case went on to the appellate court, which affirmed the lower trial court’s decision in favor of the government. What is relevant to the current debate with Foster Farms boils down to the definition of the term “adulterated,” which is defined in the statute as: (1) if it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance, such article shall not be considered adulterated under this clause if the quantity of such substance in or on such article does not ordinarily render it injurious to health. USDA’s position, which was the prevailing position per the lawsuit decision, was articulated in a letter from USDA on Aug. 18, 1971, and cited in the appellate opinion, which stated: “The ‘American consumer knows that raw meat and poultry are not sterile and, if handled improperly, perhaps could cause illness.’ In other words, American housewives and cooks normally are not ignorant or stupid and their methods of preparing and cooking of food do not ordinarily result in Salmonellosis.” The court’s opinion that Salmonella in raw poultry is not an adulterant is the reason why Foster Farms did not conduct a voluntary recall nor was there a withdrawal of USDA from the plant, which would in effect close the processing facility. Furthermore, the plant must be operating within the numerous USDA regulations or else there would have been significant negative consequences up to and including the withdrawal of inspection. In contrast to the poultry producer, Costco’s El Camino Real store in South San Francisco, CA, voluntarily recalled 9,043 units (approximately 39,755 lbs.) of rotisserie chicken products that may be contaminated with a strain of Salmonella Heidelberg, according to USDA’s Food Safety and Inspection Service (FSIS). Costco recalled 8,730 “Kirkland Signature Foster Farms” rotisserie chickens and 313 total units of “Kirkland Farm” rotisserie chicken soup, rotisserie chicken leg quarters, and rotisserie chicken salad. The products were sold directly to consumers in a Costco located at 1600 El Camino Real, South San Francisco, CA, between Sept. 11 and Sept. 23, 2013.(9) The initial recall was initiated on Oct. 12, 2013, due to concerns about a group of Salmonella Heidelberg illnesses that may be associated with the consumption of rotisserie chicken products prepared in and purchased at the Costco El Camino Real store. On Oct. 17, 2013, Costco’s El Camino Real store in San Francisco, CA, voluntarily recalled an additional 14,093 units of rotisserie chicken products that may be contaminated with a strain of Salmonella, USDA’s Food Safety and Inspection Service (FSIS) announced. This was in addition to the 9,043 units that were recalled on Oct. 12. The products subject to recall were 13,455 “Kirkland Signature Foster Farms” rotisserie chickens and 638 total units of “Kirkland Farm” rotisserie chicken soup, rotisserie chicken leg quarters, and rotisserie chicken salad. The products were sold directly to consumers in a Costco located at 1600 El Camino Real, South San Francisco, CA, between Sept. 24 and Oct. 15, 2013.(10) These recalls were appropriate and in the best interest of public health since it was in a ready-to-eat product, which all consumers have a right to expect is pathogen-free. Conversely, Tyson Foods Inc., a Sedalia, MO, establishment, voluntarily recalled approximately 33,840 pounds of mechanically separated (raw) chicken products that may be contaminated with a Salmonella Heidelberg strain, USDA’s Food Safety and Inspection Service (FSIS) announced today (Jan. 10, 2014). The mechanically separated chicken products were produced on Oct. 11, 2013. The following products are subject to recall: 40-lb. cases, containing four, 10-lb. chubs of “TYSON MECHANICALLY SEPARATED CHICKEN.”(11) This product was not available to the consumer, and, in fact, was for institutional customers (this was from a correctional facility). Salmonella’s status as a possible adulterant has been litigated, resulting in courts not considering salmonella an adulterant. From a public health law perspective, unless Congress passes specific legislation and it is signed into law by the president naming salmonella as an adulterant, raw poultry with salmonella will continue to not be considered adulterated and, therefore, will not be subject to involuntary or mandatory recall or plant shutdown. I think the public policy facet of this debate is more interesting than the recalls themselves. As referenced earlier, USDA settled the legal case in exchange for consumer education in the early 1970s. At that time, and, to an extent, to this date, all USDA offered were public service spots on radio and television, particularly around holidays and other times with heavy public consumption of meat and poultry. However, USDA’s FSIS (Food Safety and Inspection Service) also adopted mandatory Safe Handling Instructions (reproduced below), which are described in the Code of Federal Regulations, title 9, parts 317 and 381. In reality, I believe these mandatory Safe Handling Instructions gave credence to Dr. Sussman and the APHA’s position in the litigation. Furthermore, I believe consumer warnings would have potentially prevented untold illnesses and deaths from raw meat and poultry, if they had commenced decades earlier. Safe Handling Instructions This product was prepared from inspected and passed meat and/or poultry. Some food products may contain bacteria that could cause illness if the product is mishandled or cooked improperly. For your protection, follow these safe handling instructions.

Keep refrigerated or frozen. Thaw in refrigerator or microwave.
Keep raw meat and poultry separate from other foods. Wash working surfaces (including cutting boards), utensils, and hands after touching raw meat or poultry.
Cook thoroughly.
Keep hot foods hot. Refrigerate leftovers immediately or discard.(12)

The historic problem, and the rationale for the Safe Handling Instructions, is that consumers lacked appropriate hand-washing practices and strategies to prevent cross-contamination between raw poultry and ready-to-eat foods as well as adequate and verifiable thermalization of poultry to ensure thermal kill of Salmonella and any other pathogens. Therefore, the American consumer – whether in their kitchen or in a ready-to-eat processing plant, an institution such as a healthcare facility or university or retail food establishment – must pay acute attention to hand-washing, not cross-contaminating raw and ready-to-eat food products, and thermalization of poultry to 165 degrees F, verified with a calibrated thermometer. Although it would be ideal to have a guarantee that no pathogens would be present on raw poultry, or for that matter raw beef, seafood, shellfish, fruits and vegetables, it is not a reality. Eradicating pathogens from raw food is likely not possible without getting into another thorny issue, which is irradiation of food. If poultry were irradiated, there would be no Salmonella in raw poultry! However, until the government passes law otherwise, it is incumbent on consumers to be vigilant and take precautions to ensure pathogen prevention. References: (1) The exact statistic has varied in numerous studies as described in a June 30, 1966, article in the New England Journal of Medicine entitled, “Isolation of Salmonella from Poultry. “Arthur Wilder. Isolation of Salmonella from Poultry. The New England of Journal of Medicine. Volume 274, Number 26. June 30, 1966. (2) American Public Health Asso. v. Butz. 511 F.2d 331 U.S. App. (1974). (9) http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2013/recall-058-2013-release (10) http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2013/recall-058-2013-expanded (11) http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2014/recall-001-2014-release (12) http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/teach-others/download-materials/image-libraries/safe-handling-label-text/ct_index

Raw Milk: Public Health Enemy or Nature’s Gift?

Dr. Mel Kramer — Mon, 30 Apr 2012 01:59:07 +0000

There has been much debate recently on the benefits/drawbacks of pasteurized versus raw milk. In Ohio, it is illegal to sell unpasteurized milk to stores and consumers, though dairy farm families may drink raw milk from their own herds.

In 2006, the Ohio Department of Agriculture revoked the license of a 100-cow dairy on grounds that it was selling raw milk. In light of this decision and similar rulings nationwide, there is a growing movement to allow consumers to directly purchase raw milk from farmers, thus, bypassing the regulatory mandates of state agriculture departments.

Individuals have the right to purchase and eat whatever food and beverage items they see fit for consumption, e.g. people eat raw oysters despite the risk of contracting pathogens such as Vibrio parahaemolyticus, or they can order their hamburger rare despite the risk of obtaining E. coli O157:H7. What is important is the familiar caveat: “buyer beware.”

Unfortunately, much information promoting the purported benefits of raw milk and the alleged evils of pasteurized milk is making the rounds in cyberspace. This disinformation and pseudo-science campaign needs to be addressed in order to allow consumers to make an informed choice about the milk they drink.

One argument made by raw milk advocates is that pasteurization kills “good” bacteria and enhances growth of harmful bacteria. While it is true that pasteurization destroys bacteria, that is precisely the intended benefit. Bacterial species such as E. coli, Salmonella and even Mycobacterium tuberculosis, the causative agent of tuberculosis, reside in the gut of cows. These microorganisms, harmless to cows, can contaminate raw milk and cause serious infection in humans. Pasteurization eliminates these pathogens.

The counterpoint – pasteurization destroys beneficial bacteria – is worthless. Bacteria are everywhere in the environment – found in soil, water, most foods and even on the outer layer of human skin. Due to the universal nature of bacteria, people are almost constantly ingesting microbes, which then colonize the gut.

The only way to eliminate the normal flora (bacteria that normally grows in the digestive tract and protects humans from opportunistic pathogens) is long-term antibiotic treatment. Drinking pasteurized milk will not have any diminishing effect on the normal flora of human intestines. Another nugget of disinformation raised by raw milk proponents is that pasteurized milk increases the risk of diseases such as cancer and osteoporosis.

These advocates state the fact that cancer rates were much lower before pasteurization was mandated. This argument is inherently misleading. There are many causes of cancer, involving complex interactions of genetics and environmental factors. Regardless of what precisely triggers cancer, the increase in various malignancies is largely due to the fact that humans live much longer lives than they did 100 years ago.

Prior to the 20th century’s advancement in food production, sanitation and medicine, the life expectancy was only 40-50 years of age and the most common cause of death was infectious diseases, primarily tuberculosis, pneumonia, influenza and diarrheal illnesses. Cancer, heart disease and stroke are now the three most common causes of mortality for the simple reason that people in developed countries often live into their 70s, 80s or beyond, thus giving time for chronic diseases to take hold.

Pasteurization of milk has little, if anything to do with this trend. As for osteoporosis, vitamin D is required for the absorption of calcium from the gut. Humans produce their own vitamin D from sunlight, as well as receive it from processed milk, which is fortified with this nutrient.

Raw milk does not contain vitamin D, therefore, less calcium absorption occurs from drinking raw milk than pasteurized milk. Proponents of raw milk also argue that pasteurization of milk destroys enzymes that aid in digestion of foods. One website even claims that drinking pasteurized milk “puts a strain on the pancreas,” (which secretes many digestive enzymes).

This could not be further from the truth. Enzymes found in raw milk are bovine enzymes, which, as foreign proteins, are destroyed naturally by the human digestive tract. Humans are incapable of using bovine enzymes to aid in digestion. Only enzymes produced by one’s own salivary glands, stomach and pancreas are useful for humans.

In conclusion, people have the right to drink raw milk if they think it better suits their taste. However, they should be forewarned that much of the information promoting the benefits of raw milk is overblown or worse, patently false.

Research conducted by credible scientists and organizations, including the FDA, overwhelmingly argues in favor of pasteurized milk’s benefits versus raw milk. So before anyone chooses to switch to raw milk, they must be properly educated on the facts, then they can make a truly informed decision on what goes into their body.

Illness from raw milk is 100 percent preventable and needs no additional rules, laws, inspections or audits. Consumption of pasteurized milk is not “erring on the side of caution,” it is a proven method of eliminating disease from this commodity.

This year, there have been an increasing number of cases of E. coli O157:H7 attributable to the consumption of raw milk. These cases, the ensuing human suffering and the mounting health care costs are 100 percent preventable. It is our responsibility as public health professionals to prevent and to advocate for interventions and modalities that will reduce the burden of illness in our society.

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Melvin N. Kramer, Ph.D., M.P.H., is president of EHA Consulting Group, Inc.

California Cow with BSE (Mad Cow Disease) Does Not Pose a Threat to the Food Supply

Dr. Mel Kramer — Thu, 26 Apr 2012 01:59:07 +0000

On April 24, 2012, it was announced that the fourth U.S. cow tested positive for BSE. In truth, the first U. S. cow, which was imported from Canada, had “typical” BSE, which was identified in the United Kingdom and has been present in both Europe and Japan, and to a lesser extent in Canada. The two previous U. S. cattle were actually atypical, as was the one identified this week.

Although scientifically less is known about the etiology or causation of atypical BSE, what is known is it is not acquired the same way as the typical BSE (from consuming infected feed containing the brain or other Specified Risk Materials from an infected animal), nor does it seem to present the same danger, even if consumed. No animal slaughtered in the United States for human or animal feed can contain Specified Risk Material, which is where the prion (not bacteria or virus) can be found. This includes the brain, the tonsils, and parts of the intestine, as well as the spinal cord.

This fourth cow from California was found during the routine surveillance of USDA, APHIS (Animal Plant and Health Service). This cow was presented for slaughter in an ambulatory fashion (not a “downer”) and was to be incorporated in pet food, but again, none of the Specified Risk Materials would have been included in the pet foods.

There is no evidence that non-ruminant animals actually get BSE; however, there are quite a few ruminants that humans consume other than cattle – including buffalo, sheep, goat, and elk. The human form of BSE is new variant Creutzfeldt-Jakob Disease (vCJD) which is highly and actively looked for in the United States through a variety of modalities, including biological materials sent to the National Prion Disease Surveillance Center in Cleveland, Ohio.

Since they started actively looking for vCJD, which would have been from cow, three cases in the United States were identified with none having their exposure to U. S. beef. Their risk factors were two from the United Kingdom and one from Saudi Arabia, who most likely had exposure in the UK and/or the EU.

The U. S. has worked very hard to try to assure not only its citizens, but also its trading partners around the world, that due to excellent decision making in the 1980s with regard to the importation of cattle and bone meal, as well as later on in the discontinuation of feeding any of the Specified Risk Materials to cattle or other food animals and embarking on an intensive surveillance program, that the United States, in effect, is free from BSE and should not be worrisome to the American consumer nor our trading partners around the world.

The bottom line is that this cow does not pose a food safety issue. One can only hope that the news media will not make more out of this and, if they want to increase food safety awareness and prevent foodborne diseases, they will do stories on cooking ground beef to 160 degrees Fahrenheit, poultry to 165 degrees Fahrenheit and don’t cross-contaminate between raw and ready-to-eat burgers or poultry and, of course, frequent handwashing.

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Melvin N. Kramer, Ph.D., M.P.H., is president of EHA Consulting Group, Inc.