A few weeks ago a nation that loves to agonize over fat, cholesterol and food additives got a jarring bit of news. Writing in the Journal of the American Medical Association, a team of public-health officials described how 23 people in southeastern Massachusetts had contracted a potentially deadly illness from a product most purists adore. The 23 New Englanders had suffered from bloody diarrhea, and in some cases kidney failure, after drinking apple cider in the fall of 1991. The cider was fresh, local and free of chemical additives, but it contained something more dangerous: a new microbe called E. coli 0157:H7.
The cider story was just the latest warning that a deadly new germ is on the march. Last January, when several kids turned up with the same symptoms at Children's Hospital in Seattle, tests implicated the same obscure strain of E. coli. Within days state health officials traced the outbreak to contaminated, undercooked hamburgers from Jack-in-the-Box restaurants. The fast-food chain promptly recalled thousands of frozen meat patties and tightened its cooking standards. But by that time, its outlets had already sold tainted burgers in four states. The result: 477 people got sick-nearly a third of them sick enough to require hospitalization-and at least one toddler died.
These E. coli outbreaks, along with a smaller one involving mayonnaise in Oregon this spring, have cast a harsh light on the safety of America's food supply. It's still possible to eat safely (page 54), but virtually everything about the way we produce, distribute and consume our food has changed during the past few decades. New farming techniques have made animals more susceptible to infection-and large-scale food distribution has ensured that when tainted food gets out, it travels far beyond the local church picnic. At the same time, our growing reliance on prepared and imported foods has created new conduits for contamination. Rather than keeping pace with these changes, however, the public agencies we rely on to protect us have either ossified or run out of resources. Now, thanks largely to the Jack-in-the-Box fiasco, officials are admitting as much-and calling for radical reform. "We have a piecemeal, haphazard system that needs to be replaced by a comprehensive system," says Dr. David Kessler, commissioner of the Food and Drug Administration. "This is a major challenge for the rest of the decade."
Depending on the bug, the dose and the victim, tainted food can cause everything from miscarriages and kidney disorders to meningitis and permanent brain damage. The government doesn't monitor foodborne disease as it does syphilis or gonorrhea, so no one knows just how pervasive it is. The best casualty tolls were calculated in 1985 by researchers at the Centers for Disease Control and Prevention (CDC). They concluded that 6.5 million Americans are stricken every year and that 9,100 die. Though no one has compiled a more recent tally, experts agree that the situation is growing ever dicier. "Are the dangers greater today than 10 years ago?" asks Dr. Robert Tauxe of the CDC's Foodborne and Diarrheal Diseases Branch. "Definitely."
One problem is that the microbial landscape is changing. A number of new pathogens have shown up in the food supply in recent years, and old ones are finding new ways to make mischief. Dr. Paul Blake, chief of the foodborne-diseases branch at the CDC, recalls an unusual British report that came across his desk in 1977. A researcher had found evidence of severe gastroenteritistwo to 10 days of diarrhea, vomiting and fever-caused by a germ called Campylobacter. "Nobody here had ever heard of Campylobacter," Blake says. Since then, Campylobacter has become the developed world's leading foodborne pathogen. It has turned up in cheeses and shellfish, but is rampant in chicken and raw milk. In a retrospective study, researchers from the CDC and the Minnesota Department of Health recently found that 20 Campylobacter outbreaks occurred during the 1980s among schoolchildren who drank raw milk during field trips to dairies. Of 1,000 kids in 11 states who took part in that rite, nearly half had been stricken.
Salmonella is another bug on the move. Reported poisonings from beef, poultry and dairy products have doubled since the 1960s. At the same time, devious new strains are growing ever more pervasive. During the late '70s and early '80s, the Northeastern states experienced a sixfold increase in disease outbreaks caused by Salmonella enteritidis, a strain found mainly in eggs. The bug has since taken hold nationwide, causing 375 outbreaks between 1985 and 1991 and raising new concerns about the safety of a food found in virtually every American fridge.
Because Salmonella often spreads through fecal contamination, experts once thought that clean, unbroken eggs posed little risk. But unlike most Salmonella, the enteritidis strain seems to hide in hens' ovaries and infects developing eggs before they form shells. Neither hen nor chick suffers any symptoms, but anyone eating undercooked eggs can be laid low. Most people suffer only six to 48 hours of misery, but the effects can be harsher in children, pregnant women and people with suppressed immune systems.
E.coli 0157, the culprit in this year's Jack-in-the-Box outbreak, was first recognize as a human pathogen just 11 years ago, when people in two states got sick from hamburgers, and investigators found the microbe in the meat. Today it seems to be turning up everywhere. Beef is the most common source of trouble, but 0157 has also turned up in pork, lamb, chicken, turkey and potatoes. Its recent appearance in apple cider and a restaurant's mayonnaise was doubly unsettling, because E. coli can't normally survive in such acidic environments.
Unlike more common strains, which move harmlessly through our intestines, E. coli 0157 clings to the intestinal wall and produces a toxin that can cause widespread internal bleeding. Most patients recover after a week or so, but 2 to 7 percent suffer a complication called hemolytic uremic syndrome, or HUS, a destruction of red blood cells that can lead to kidney failure,seizures and death. In just one decade, 0157 has become the leading cause of acute kidney failure in children, and experts warn that it has equally menacing cousins. "Why the others are less prevalent in human disease remains a mystery right now," says Dr. Douglas Archer of the FDA's Center for Food Safety Programs.
These emerging microbes have all been fostered by changes in the way we produce, distribute and consume our food. Modern farming techniques virtually guarantee rapid transmission of microbes among the animals we eat. In the U.S. beef industry, some 900,000 farms produce calves, which are typically shipped to one of 46,000 feedlots for finishing, and later to one of 81 large plants for slaughter. Because so many cattle pass through these "choke points," an obscure bug from one farm can ignite an epidemic.
Other farming practices compound the effect. Rather than waste the guts of slaughtered chickens, for example, growers often add them to animal feed for extra protein. The fortified feed spreads Salmonella and other germs. Because most farm animals also receive low doses of antibiotics to enhance growth, those germs are often drug-resistant. And when they end up in the food supply-as they did in northern Illinois in 1985-the results can be devastating for some people. An estimated 175,000 got sick during the outbreak, after drinking milk from a regional dairy. A study later found that people who had taken antibiotics within a month of the outbreak fell ill at five times the general rate. The antibiotics had cleared their digestive tracts of normal bacteria, enabling the drug-resistant Salmonella to take root and multiply freely.
As mass production has created new dangers, so has our reliance on imports. A greater share of the American diet comes from offshore than ever before. "You can't say we have the safest food supply in the world," says the CDC's Tauxe. "Ours is the food supply of the world. One bite of a fastfood hamburger can introduce you to beef from four countries." The FDA samples imported foods to ensure they meet U.S. safety and labeling standards. But only 2 percent of the imports are actually inspected, and the agency can't police food handling outside U.S. borders. In 1990, people in 30 states fell ill after eating cantaloupe that had been trucked across Mexico in ice made with local river water. Imported cantaloupes were also linked to a 1991 Salmonella outbreak that struck at least 400 people in 23 states. The lesson, says CDC scientist Morris Potter, is that we can now enjoy "Third World diseases with all the comforts of home."
Food production isn' t all that has changed in recent decades. Shifts in the American diet, some of them laudable, have created still other hazards. The National Restaurant Association says consumers now spend 43 cents of every food dollar on meals eaten away from home, up from 25 cents in 1955 and 36 cents in 1980. There's nothing inherently wrong with prepared foods, but the extra handling they receive creates new opportunities for contamination. Nine million food-service workers now prepare much of what America eats. Most of these are low-pay, high-turnover jobs, and hygienic training ranges from excellent to nil.
At the same time, health-conscious consumers are eating more fresh fruit and vegetables, and eating them less cooked. From the heart's perspective, that's a trend to celebrate, but it has further complicated the issue of food safety. "The heart-healthy diet has not been equally kind to the gastrointestinal tract," says Minnesota state epidemiologist Michael Osterholm. Microbiologist Michael Pariza of the University of so Wisconsin's Food Research Institute concurs, noting that many of today's big Salmonella outbreaks come not from processed meats and poultry but from salad bars. Because they combine foods requiring different levels of cleaning, cooking and refrigeration, salad bars make perfect microbial playgrounds. And even when they're well maintained, they can transmit germs from one patron to the next. As Pariza puts it, "You don't know who last touched the scoop that falls in the dressing."
To make matters worse, a growing segment of the population lacks normal resistance to foodborne pathogens. A healthy immune system can often expel a bacterial invader before it causes any illness. That's why we eat without problems most days. But even a fairly benign microbe can immobilize a person whose defenses have been compromised by age, chemotherapy, kidney dialysis or HIV infection. Listeria monocytogenes, a microbe found in a wide variety of foods, rarely causes illness in healthy adults. But as the immunocompromised population grows, so does the bug's impact. Though foodrelated listerial disease was unheard of a decade ago, it now strikes more than 1,800 Americans every year, and a fourth of them die.
No one expects government or the food industry to reverse these social trends, and reasonable people concede that there is no way to guarantee the purity of every morsel of food that every consumer ingests. But all parties now agree on the need for new approaches to food safety. As a General Accounting Office official said recently, "The federal food-safety inspection system is inconsistent, inefficient and unable to adjust to changing public-health risks." The U.S. Department of Agriculture, which regulates meat and poultry production, is virtually blind to problems like E. coli contamination. Operating under laws passed in 1906, the USDA's 7,400 meat inspectors spend their days in processing plants, touching, sniffing and eyeballing animal carcasses in search of physical signs of disease. If a pathogen is invisible, it's basically home free.
Meanwhile, the agencies responsible for monitoring outbreaks of foodborne illness are often too cash-strapped to try. Saddled with the AIDS epidemic and various congressional directives, the CDC this year budgeted a paltry $3 million for the task. The agency's foodborne-diseases branch has fewer than three dozen employees, several of them medical residents serving two-year stints. "We've got the most rudimentary surveillance of foodborne disease you can imagine," says Dr. James Hughes, the CDC official who oversees the branch. The system consists basically of state health departments reporting outbreaks that come to their attention. If the state epidemiology staff is underfunded or incompetent, the outbreak isn't reported.
Spurred by the recent E. coli outbreaks and the arrival of a new administration, several agencies are now pushing blueprints for reform. Even before the outbreaks started, the CDC was working on plans for a "sentinel surveillance system" with 10 regional centers set up specifically to detect and monitor emerging diseases. In addition, the agency's foodborne-diseases branch is now proposing measures to improve the tracking and reporting of foodborne illness, with special emphasis on E. coli 0157 (which few diagnostic labs now test for).
The USDA, for its part, wants to replace its antiquated inspection rituals with a unified system that would follow food from the farm to the supermarket, addressing potential hazards at every step along the way. Inspectors would rely less on physical exams to spot contamination, but because bacterial tests are slow and costly to administer, prevention would be the main emphasis. The FDA is now devising a similar proposal, and Minnesota Sen. Dave Durenberger is pushing a more sweeping reform: the creation of a single agency to handle all food-safety and inspection services.
If any of these reforms take shape, they could make 1993 the biggest year for food protection since 1906, when Congress passed the landmark federal meat-inspection law. Compared with guns or cigarettes, tainted food is still a nascent public-health problem, but that's no reason for complacency. The microbial world is full of unpleasant surprises, and as the recent E. coli outbreaks make clear, we haven't seen the last of them. As one official puts it, we've created a wide-open conduit, and no one knows what will come down it next.
Is there any good news about food? Maybe this: it's actually pretty easy for home cooks to prevent foodborne illness. And despite what many foodsafety experts seem to imply, you do not have to don surgical garb and sterilize the spoons and whisks in order to make lunch.
Animal foods are the worst offenders, from a safety point of view, so they should be handled carefully. Keep raw meats separate from other foods, and watch out for the raw meat juices, which can linger on a cutting board or platter and contaminate the next food item that is placed there. Barbecues are often particularly friendly to germs. If you carry raw meat to the grill on a plate, don't put the cooked product back on the same plate. Similarly, don't cut up raw chicken and then use the cutting board for the garlic; wash the board first, and the knife, too. For years cooks have been advised to use plastic cutting boards for safety, on the theory that wooden boards harbor bacteria more easily. But recent tests conducted at the University of Wisconsin gave wooden boards a big advantage over plastic; for unknown reasons, the wood was much less hospitable to the bacteria. The USDA, which has a food-safety hot line (1-800-535-4555), advises consumers to wash all boards very carefully. Generally, meats should be cooked until there's no pink; eggs, until both whites and yolks are firm. Ground meats require extra care. E. coli bacteria live on the surface of meats and are easily killed by the heat on, say, the outside of a steak. But in ground meat, outer surfaces get mixed up in the middle of patties, where they often don't get enough heat to kill the germs. Microwave cooking also calls for extra safety measures, since the ovens cook unevenly. According to the USDA, you should use a meat thermometer to make sure that meat has reached at least 160 degrees and that chicken parts reach 170 degrees. For whole chicken, it's 180 degrees. Check in a couple of places, not just one. The USDA suggests covering the dishes, too, since the steam kills bacteria.
Fruits and vegetables are less likely sources of microbial contamination, at least until human hands get to them. The less distance the produce travels, the fewer chances there will be for contamination. Sometimes imported produce is all that's available, but look for local fruits and vegetables in season. (Check the carton or crate for a label, or ask the produce manager.) Farmer's markets are excellent sources of local goods. No matter where it comes from, all produce should be washed thoroughly.
Kosher poultry is one fairly accessible way to play it safer. The requirements for kosher certification call for such extraordinary standards of cleanliness that most bacteria don't stand a chance, Also, some farmers raise animals without antibiotics, in welltended conditions that help prevent disease. Look for labels that sell just these points. The products tend to be expensive and often hard to find except in health-food stores, but a few brands-Coleman Natural Meats, for example-are starting to show up in supermarkets. There's still no hard proof that they provide health benefits. But what they do is cut down some of the opportunities for contamination, especially those caused by our changing food industry. Like all the methods described here, they reduce the risk,