by Marion Nestle

Currently browsing posts about: Food-safety

Dec 27 2011

What’s with the problems with powdered infant formula?

Mead Johnson Nutrition says it has tested additional samples of its Enfamil baby formula and still does not find the bacteria responsible for the death of one newborn infant and the illness of another.

The bacteria at fault are Cronobacter sakazakii, formerly known as Enterobacter sakazakii (bacterial taxonomists proposed this reclassification in 2007).

Last week several retailers pulled Enfamil infant formula from their shelves because of fears that Enfamil was contaminated with this organism.

Walmart was the first to issue a recall.

The retailers actions were unusually cautious.  Neither Mead Johnson nor federal investigators had evidence that the formula caused the illnesses.  Federal agencies had not asked for a recall.

But the retailers must have connected the dots:

  • The most likely source of C. sakazakii is powdered infant formula.
  • The two infants ill with C. sakazakii were fed Enfamil powdered formula (although the second ill infant drank several kinds of formulas).

In the chapter on infant feeding in my book, What to Eat, I noted that the main difference between one kind of infant formula and another is its cost.  Powdered formula is much cheaper than the already reconstituted kinds.  I asked:

Beyond the difference in cost, does it matter which level of convenience you choose?

It might.   Powdered formulas are not sterile.  In this, they differ from concentrate and ready-to-serve formulas, which have been heated to sterilize them.

In 2002, the FDA warned pediatricians that powdered milk formulas could be contaminated with Enterobacter sakazakii, a type of bacteria that causes rare but terrible and sometimes fatal infections in infants, especially those who are premature, weak, or in hospitals.

The FDA says it is not aware of any E. sakazakii infections in healthy full-term infants in home settings.

Reports from other countries, however, suggest that even healthy babies may sometimes acquire such infections [see Kwan Kew Lai, “Enterobacter sakazakii infections among neonates, infants, children, and adults: case reports and a review of the literatur,”(see:  Medicine, Vol. 80, pp. 113-122, March 2001.]

In 2001, the CDC published a case report on this type of infection.  It pointed out that “…in 50-80 % of cases, powdered infant formula is both the vehicle and the source (direct or indirect) of E. sakazakii-induced illness.”

The CDC’s conclusion:

Clinicians should be aware of the potential risk for infection from use of nonsterile enteral formula in the neonatal health-care setting.

The World Health Organization has a Q and A:

3. How does infant formula get contaminated with Enterobacter sakazakii? Can other foods also be contaminated?

Basically there are three routes by which Enterobacter sakazakii can enter infant formula:

a) through the raw material used for producing the formula;

b) through contamination of the formula or other dry ingredients after pasteurization; and

c) through contamination of the formula as it is being reconstituted by the caregiver just prior to

feeding.

Enterobacter sakazakii has been detected in other types of food, but only powdered infant formula has been linked to outbreaks of disease.

So the recalls were precautionary.  It’s hard to argue with that—unless you are a stockholder; Mead Johnson stocks declined by 5% as a result.

At the moment, the source of these particular C. sakazakii infections is unknown.  Let’s give the retailers credit for taking precautions to protect the public.

As for infant feeding in general: Breastfeeding is best, of course.  If you are using formulas to feed your infant, the liquid ones are safer—but much more expensive.

Dec 15 2011

More problems with FDA’s ability to inspect food facilities

The Office of Inspector General (OIG) of the Department of Health and Human Services, FDA’s parent agency, has just issued a report sharply criticizing FDA’s oversight of State food inspections.

This report is one more piece of evidence for how FDA’s lack of resources makes our food supply less safe.

Because it does not have the personnel to do its own inspections, FDA increasingly delegates them to State agencies.  The Salmonella outbreak from peanuts in 2009 is a prime example of why the State system is too diffuse to work.  As the report explains,

The peanut processing plant responsible for a 2009 salmonella outbreak was inspected multiple times by a State agency working on behalf of FDA. This outbreak resulted in one of the largest food recalls in U.S. history and has led to serious questions about the effectiveness of State food facility inspections.

FDA has long been unable to inspect more than a tiny fraction of food processing facilities and the situation is getting worse, not better: the overall number of facilities inspected decreased from just over 17,000 facilities in 2004 to about 15,900 in 2009 (4%-5% of the total number).

FDA increasingly goes to States to fill the gap.  In 2009, it contracted with 41 States to conduct inspections, and these conducted 59% percent of FDA’s food inspections.  In 2004, State inspections comprised just 42% of inspections.

FDA says it has good reasons for relying on States:

According to FDA officials, one reason FDA relies on States is that these inspections are conducted under State regulatory authority, which often exceeds FDA’s own authority. For example, several FDA officials noted that, under certain conditions, State inspectors can immediately shut down a facility or seize unsafe food products, whereas FDA would have to go through a lengthy legal process to achieve similar results.

But this is not enough.  The current report is only the latest of a series of OIG reports detailing problems with FDA’s food inspections.  Previous reports found that more than half of all food facilities have gone 5 or more years without an FDA inspection.

The report concludes:

Taken together, the findings demonstrate that more needs to be done to protect public health and to ensure that contract inspections are effective and prevent outbreaks of foodborne illness.

Yes, of course they do.  But how is FDA supposed to fix the problem?

Bizarrely, and at great risk to the public, FDA gets its funding from congressional agriculture appropriations committees, not health committees.

In this era of cost cutting, FDA was lucky to get a $50 million increase in funding, or so everyone says.

But this is nowhere near enough to hire and train enough inspectors to do the job right.  It’s not that the States can’t do a good job.  It’s that the dispersion of authority leaves much room for flexibility in interpretation and lack of accountability, as the OIG reports consistently show.

For reasons of politics, this may not be the time to demand a stronger food safety system.  But if not now, when?

Sep 29 2011

Since when did cantaloupe become a WMD*?

Are you as puzzled about the latest cantaloupe outbreak as I am?  This time it’s Listeria again (see previous post on this particular pathogen).

According to the CDC, 72 people have been infected with the strains of Listeria associated with the outbreak in 18 states.  Most appalling,  13 people have died.

The CDC says that the people who have become ill range from 35 to 96 years, with a median age of 78 years.  Most are over age 60 or have health conditions that weaken the immune system.  Pregnant women are at especially high risk as are their fetuses.

As always, the recall occurred after most of the cases were reported to the CDC.  The cantaloupe were traced to Jensen Farms, which issued a recall on September 14.

Why cantaloupe?  They are, after all, grown in dirt and their skin is rough, textured, and has plenty of places for bacteria to hide.  People pick up Listeria by handling the fruit and cutting into it.  FDA’s information page lists the recalls and press releases on the Jenson Farms outbreak.

The FDA’s advice: throw it out.

Do not try to wash the harmful bacteria off the cantaloupe as contamination may be both on the inside and outside of the cantaloupe. Cutting, slicing and dicing may also transfer harmful bacteria from the fruit’s surface to the fruit’s flesh.

What do food safety experts say you have to go through to avoid getting sick from eating cantaloupe?

  • Wash the melon under running water with a clean vegetable brush.
  • Blot with paper towels to remove excess water.
  • Put melon on a clean surface, one that hasn’t come into contact with meat or poultry or other foods that could cause cross-contamination.
  • Cut off the stem end about 3/4 to 1 inch from the end, using a clean kitchen knife.
  • Place melon on a clean cutting board, plate, or other clean surface with the cut end facing down.
  • Using a clean knife, cut the melon from the blossom end to the stem end.
  • Follow this by washing the knife with clean running water and setting it aside.
  • Gently scrape out the seeds with a clean spoon and cut the melon into slices or whatever is desired.
  • Don’t use dish soap or detergent; cantaloupes can absorb detergent residues.
  • Do not allow the rind to touch any part of the edible fruit.
  • Melon that isn’t eaten should be peeled, covered and refrigerated.
  • Discard any melon that has been at room temperature for longer than 2 hours, or 1 hour when the temperatures are over 90 degrees F.
  • Follow these procedures for all melons, no matter where they were grown.

What?  No HazMat suit?

We are talking about cantaloupes here.

How about a food safety system where everyone makes sure—and tests—that Listeria don’t get on cantaloupe in the first place.

Single food agency anyone?

_____

*Translation: Weapon of Mass Destruction

Aug 30 2011

Don’t like bothering with food safety rules? Sue the FDA!

In an astonishing display of what can only be described as chutzpah* Del Monte sued the FDA for insisting on a recall last March of its cantaloupes likely to be contaminated with a toxic form of Salmonella Panama. Now Del Monte is also suing the State of Oregon.

On what grounds?

Notably, “[t]he FDA investigation ultimately found no connection between Del Monte Fresh cantaloupes and any cases of Salmonella Panama, including in Oregon,” the company says. “FDA issued a notice ending the recall on July 29, 2011.”

The CDC thinks otherwise.  Its investigations pointed to imported Del Monte cantaloupes as the source of an outbreak that affected 20 people in several states:

Twelve of 16 ill people reported eating cantaloupe in the week before illness. Eleven of these 12 ill people ate cantaloupes purchased at eight different locations of a national warehouse club. Information gathered with patient permission from membership card records helped determine that ill persons purchased cantaloupes sourced from a single farm. Product traceback information indicated these cantaloupes were harvested from single farm in Guatemala.

FoodSafetyNews reviews the history of this particular recall.  It agrees with Del Monte that tests performed in April on cantaloupe samples from the Guatemala farm came out negative for Salmonella and that the FDA has now ended the recall.  But:

Del Monte had announced the recall in March, after the suspect melons had passed their shelf-life date. It is not clear whether any of the cantaloupes tested were actually the suspect melons. In foodborne illness investigations, samples of the food from the same batch eaten may no longer available by the time the connection to an outbreak is made. Epidemiology, rather than a contaminated sample, is the evidence that points to a likely source.

For these reasons, attorney Bill Marler terms the lawsuit “frivolous.”  He is suing Del Monte on behalf of a sick client.

Public health agencies doing their jobs to protect the public now have to defend against lawsuits like this?  Putative cause is no longer enough to order recalls?

U.S. courts are not famous for understanding epidemiology or other aspects of public health and I’m wondering what effect this suit will have on public protection against foodborne illness.  What standard of proof will the courts require?

Lawsuits are chilling.  Congress has just granted the FDA the authority to order recalls.  Food producers were not happy about that provision.  This is one way to get around Congress and the FDA.

It is worth asking who gains and who loses from lawsuits like this.

*Hence: chutzpah, which if you aren’t familiar with the term, is the Yiddish word for outrageous audacity.

Aug 11 2011

Q. What’s with the turkey recall? A. Same old, same old

I’ve been rounding up information about the Cargill recall of ground turkey contaminated with Salmonella Heidelberg.  William Neuman at the New York Times related the story on August 3. Same old same old.

Cargill is a huge company with, as Bill Marler counts them, a long history of food safety problems.  Did Cargill not bother to test for pathogens?   As I explain in my book Safe Food: The Politics of Food Safety, no meat company wants to test for pathogens.  If they found pathogens, they would have to recall the products.

And where was the USDA in all of this?  Best not to ask.

The USDA was testing.  The testing found Salmonella.  The USDA did nothing.

According to the Wall Street Journal,

Federal officials said they turned up a dangerous form of salmonella at a Cargill Inc. turkey plant last year, and then four times this year at stores selling the Cargill turkey, but didn’t move for a recall until an outbreak killed one person and sickened 77 others.

How come?

Food-safety specialists said the delay reflected a gap in federal rules that don’t treat salmonella as a poisonous contaminant, even if inspectors find antibiotic-resistant forms such as the Heidelberg strain implicated in the latest outbreak.

But CDC investigations show that turkey-related illnesses have been reported for months.  Despite the reports, the USDA took its own sweet time insisting on a recall.

The rationale for the delay is—get this—the USDA believes it does not have the authority to order recalls for any contaminant except E. coli O157:H7.  It has no authority to recall meat contaminated with Salmonella or other toxic forms of E. coli.

Or at least that’s how USDA interprets the legal situation (for the history of all this, see Bill Marler’s summary.

One reason for the USDA’s foot-dragging must surely be pressure from the meat industry which wants as little testing as possible and preferably none.  The meat industry would rather leave it up to you to cook your food safely.

According to a report by Elizabeth Weise in USA Today,

The reasons these bugs aren’t currently regulated are a mix of politics, money and plain biology — the bacteria are constantly evolving and turning up in new and nastier forms, making writing rules about them a bit of a nightmare. For example, the German E. coli variant that sickened more than 4,075 in Europe and killed 50…wasn’t known before this spring.

The meat industry takes advantage of this situation and argues:

“We don’t have a true baseline determining the prevalence of these organisms in the beef supply,” says Betsy Booren of the American Meat Institute (AMI) Foundation, the research arm of AMI. Without knowing how common they are, it’s impossible to say whether they should be considered adulterants, she says.

What they seem to be saying is that meat always has bacteria on it.  And just because these particular bacteria can kill people doesn’t mean the industry is responsible if anyone gets sick.  But shouldn’t the industry be doing a better job?

In Food Safety News, Michele Simon has a terrific analysis of the safety loopholes that allow this absurd situation to continue:

How did the meat industry get so powerful that it can keep USDA from doing its job? Now, instead of preventing illnesses from occurring by requiring testing with teeth, we have USDA regulations that are so lax they allow almost half the samples tested at ground turkey plants to be contaminated with Salmonella — a pretty easy standard to meet. And one that allowed this outbreak to occur.

I keep asking: how much worse does it have to get before Congress does something about ensuring safe food.  Cargill’s inability to protect the public from unsafe meat is reason alone to create a single food safety system that unites the functions of USDA and FDA.

If Congress isn’t ready to take that step, it could at least give USDA the power to act and the FDA the funding it needs to do its job.

Jul 6 2011

How to pay for a better food system?

At TPMDC, Brian Beutler explains why the U.S. does not have enough money to pay for food assistance programs, safety regulation, better school food, or support for sustainable agriculture.

 

Jun 29 2011

USDA’s new food safety campaign: it’s all about YOU

Yesterday, USDA announced its new Food Safe Families campaign to get you to pay attention to food safety procedures in your kitchen.  These, as always, are:

  1. Clean: Clean kitchen surfaces, utensils, and hands with soap and water while preparing food.
  2. Separate: Separate raw meats from other foods by using different cutting boards.
  3. Cook: Cook foods to the right temperature by using a food thermometer.
  4. Chill: Chill raw and prepared foods promptly.

The media campaign, which reportedly cost $2 million, comes with a graphic that can’t be all that expensive:

So what is the $2 million for?  According to Food Chemical News (June 28):

The campaign, which will feature public service announcements in English and Spanish, centers on “humorous over-the-top depictions of the four key safe food handling behaviors”….The campaign will include ads on television, radio, print and websites, along with an integrated social media program.

As it happens, a reader sent me the preliminary “concept” version of this campaign (thank you kind reader).   Trust me, this campaign is worth a look, and Food Safety News has some of the videos.

Here’s my favorite concept:

Yes, this is a baby pig in a sauna.  Humorous maybe, but how will it convince anyone to clean up the kitchen?

Two other points:

  • None of the concepts seem to have anything to do with food.
  • All of them are about your responsibility for food safety.

But the big national outbreaks we’ve been experiencing lately are from foods that are already contaminated by the time they get to you.  Following food safety procedures makes good sense, but that’s not where the problem lies.  They would not help you much with contaminated raw sprouts, for example, unless you cook them (not a bad idea these days).

To stop food safety problems at their source, we need a functional food safety system.  This means rules that require all producers to follow food safety procedures and a government with the authority and resources to make sure they do.

Will we ever get a food safety system like this?  And how bad will things have to get before we do?

 

Jun 22 2011

What FDA is up against with imported foods

In an action highly unusual for the FDA, the agency has released a new “special report” on what it is up against as it tries to get a handle on the safety of imported foods.

Pathway to Global Product Safety and Quality points out that imported foods account for:

  • Between 10% and 15% of all food consumed by all U.S. households
  • Nearly two-thirds of all fruits and vegetables
  • 80% of seafood

And imported foods have increased by at least 10% during each of the last seven years and are expected to increase by 15% per year for the next several years.

The New York Times notes that in 2008 the FDA would have needed “1,900 years to check every foreign food plant at its rate of inspections at the time.”

That’s not all.  According to FDA:

Manufacturers and producers…face intense pressure to lower costs and improve productivity, fueling a cycle in which the quest for efficiency leads to increased production abroad and higher volumes of imported products to regulate.

Goods entering the U.S. will come from new and different markets, flowing through long, multistep processes to convert globally-sourced materials into finished goods.

The shift in global product flows will make it difficult to identify the “source” of a product and to ensure that all players along the supply chain meet their safety and quality responsibilities.

And it is not just legal activity that poses challenges for the FDA. Increasingly, the agency must contend with ever more sophisticated threats of fraud, product adulteration, and even terrorism.

The FDA illustrated its report with terrific graphics.  My favorite is the supply chain for canned tuna:


What will the FDA do about this problem?  It says it will:

1) Assemble global coalitions of regulators dedicated to building and strengthening the product safety net around the world.

2) With these coalitions, develop a global data information system and network.

3) Expand capabilities in intelligence gathering and use.

4) Allocate agency resources based on risk, leveraging the combined efforts of government, industry, and public- and private-sector third parties.

The FDA released its report on practically the same day that the Health and Human Services Inspector General’s office released a report highly critical of the FDA’s ability to monitor the safety of imported foods.

Because FDA’s food recall guidance is nonbinding on the industry, FDA cannot compel firms to follow it and therefore FDA cannot ensure the safety of the Nation’s food supply.

FDA did not always follow its own procedures to ensure that the recall process operated efficiently and effectively.

This kind of criticism is not new.  Just last month, the GAO issued a critical report on the FDA’s problems regulating the safety of imported seafood.  The FDA’s difficulty with recalls is that until Congress passed the food safety act last year, FDA did not have the authority to order recalls.  It had to “pretty please” ask companies to recall unsafe foods.  Now it has the authority, but Congress did not grant new resources to carry out that authority.

The New York TImes explains the reason for the FDA’s lack of oversight:

Audits of the F.D.A.’s oversight of the nation’s food system routinely find the agency’s efforts wanting, in part, the agency says, because its budget for such activities has long been inadequate. And although the new food safety law gave the agency extra supervisory powers, it is not clear how much it will be able to do, given that House Republicans have proposed cutting its budget for protective measures.

The FDA official in charge of food safety, Michael Taylor, has been discussing the vexing resource question in recent speeches.  He points out that the FDA:

Has a a huge workload. And even though public health officials are working hard, the agency will likely not meet all of its deadlines. On top of the backlog, FDA has no idea what its budget will be for fiscal year 2012.

An agriculture appropriations bill that cleared the House last week would cut food safety programs $87 million below fiscal year 2011.

The current budget situation does paint a challenging picture…a patchwork of continuing resolutions to keep the government funded — as we saw in 2011 — makes it nearly impossible to plan ahead.

When Congress gives us our budget over half way through the fiscal year it’s very difficult to use that money in as orderly a way as possible. You can’t use that money to hire the experts you need because the hiring process is such that you won’t get them hired until the end of the fiscal year

When it comes to food safety, we only have one food supply, and it is global.  That was the whole point of my book Pet Food Politics: The Chihuahua in the Coal Minea case study of how melamine in China got into American, Canadian, and South African pet foods.  If it could happen to pet food, it could happen to ours.

To monitor the safety of imported foods, the FDA neeeds to be stronger, not weaker.

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