Still a Jungle
In an environment of drug-resistant pathogens and “pink slime,” why do the food industry and government place the onus for safety on consumers?
In August 2011, Shelly Occhipinti-Krout, a 48-year-old mother of three from Parker, Colorado, became ill. Suffering from flu-like symptoms, Shelly collapsed at home and was taken to the hospital, where she went into cardiac arrest. By the time her doctors determined that she was suffering from listeria poisoning, Shelly was in a medically induced coma.
Although listeria, a bacterium, is most commonly found in prepared foods and meats, agents from the Centers for Disease Control and Prevention (CDC) Outbreak and Response Team determined that the source of the outbreak was cantaloupe from a farm in southeastern Colorado. The farm, along with distributors in Kansas City, Kansas, and Buffalo, New York, issued a recall, but not before listeria-tainted cantaloupe reached supermarkets across the country, sickening 146 people in 28 states. By the time CDC investigators concluded their investigation that December, Shelly and 29 others had died.
Shelly’s story is not uncommon. Each year, 48 million Americans suffer from illnesses caused by a foodborne pathogen. Most, if not all, who read this article have suffered from foodborne illness at one time or another. For the vast majority affected, food poisoning results in temporary gastrointestinal distress. For others, though, the effects are much more serious. According to CDC estimates, more than 125,000 Americans are hospitalized and 3,000 die each year from microbial pathogens including salmonella, E. coli, and listeria. Estimates of the cost of foodborne illness in terms of health care and lost productivity exceed $75 billion a year. Although the number of laboratory-confirmed cases has declined for some pathogens, cases of salmonella, the leading cause of hospitalization and death from foodborne illness, remain stubbornly high and have even increased slightly in recent years. In fact, many incidents of mild foodborne illness go undetected, making it difficult to monitor and track diseases accurately.
That eating a piece of cantaloupe could result in lifelong disability or death comes as a shock to most Americans, who believe we largely solved this problem back in Upton Sinclair’s day. In fact, the rules and regulations that we assume will protect us are inadequate and incomplete. Duplication and gaps in government responsibilities leave us vulnerable to a variety of risks associated with industrial food production. Meanwhile, a steady stream of worrying revelations belies any notion that the current system of protection is up to the task. Whether it is the decision by the U.S. Department of Agriculture (USDA) to use reconstituted meat treated with ammonia in the federal school lunch program (so-called pink slime) or the recent discovery that poultry producers are using a class of critical antibiotics banned from animal production in 2005, the federal government appears either unwilling or unable to protect us.
In order to truly improve food safety, government must have more effective tools to prevent foodborne illness. At the same time, problems of administrative overlap must be remedied so that we can manage the risks of our modern food system. However, the politics of food safety pose significant obstacles to reform. Whereas industry can exercise its influence through multiple means, from congressional lobbying to executive rulemaking to legal action, consumers and public health advocates have fewer opportunities to shape the debate or bend policies toward the goals of consumer protection.
This problem is compounded by a political culture that places much of the responsibility for food safety on consumers. Outbreaks of deadly pathogens might produce measured outrage, but rarely enough to prompt politicians to push for more stringent controls on industry practices or address the bureaucratic and legal shortcomings of our current regulatory regime. Successful reform requires that we reframe the food-safety issue so that industry and government accept greater responsibility for illness outbreaks when they occur.
In this regard, food safety is part of a larger struggle in American politics. Across a range of issues, be it health care, retirement security, or consumer finance, individuals and their families are forced to bear a greater share of the risks associated with modern life. The battles over food safety reflect this broader trend: Both industry and government, perhaps for different reasons, have a joint interest in shifting the onus on to consumers. The lesson of food safety is that a more vocal and empowered consumer movement will not only help protect us and our children from unsafe food, but could shift our politics in a progressive direction as well.
Pathogens and Pathologies
We have always lived with the risk of foodborne illness; methods of curing that date back millennia testify to human attempts to preserve and protect our food. In the United States, food safety became a national concern at the turn of the twentieth century. Spurred by the sensational horrors of Sinclair’s The Jungle, Congress passed the Pure Food and Drug Act and the Meat Inspection Act in 1906. The two laws marked an important first step in protecting American consumers: The Pure Food and Drug Act prevented the sale of adulterated or misleadingly labeled foods, while the Meat Inspection Act prevented sick or diseased animals from entering our food supply. The difference may be subtle, but the result was to divide authority for food safety among multiple agencies, a decision that would have important implications as the food system became more complex and new kinds of foodborne risks emerged. Today, a combination of more virulent pathogens and administrative pathologies leaves us at greater risk of foodborne illness.
Five pathogens account for almost 90 percent of the most serious cases of food-related illness (the CDC estimates four times as many are sickened by unknown or unspecified pathogens). Norovirus is the most common food-related cause of acute gastroenteritis; more than 20 million people are sickened each year, although only a fraction of those cases result in hospitalization or death. In terms of acute risk, salmonella is the leading cause of food-related hospitalizations and death in the United States with 40,000 cases reported annually. Because many milder cases go unreported, the actual number of infections is likely more than 1 million. In addition to poultry and eggs, contamination occurs in fruits, vegetables, and processed foods. The Campylobacter bacterium is also a very common source of food-related illness with as many as 2.4 million infections each year, most of them unreported.
The most common transmission is through uncooked poultry; even one drop of juice from raw chicken contains enough microbes to cause illness. In rare cases, Campylobacter infection can cause Guillain-Barré syndrome, an autoimmune disorder that results in temporary paralysis. The listeria bacterium that killed 30 people in 2011 is particularly dangerous to those with compromised immune systems. In addition, it can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection among newborn children. Finally, several virulent strains of E. coli can cause acute illness, kidney failure, and in some cases death among those infected.
We have our industrial food system to thank for these dangers. Concentrated animal production and global networks of food distribution increase the incidence and severity of foodborne risks. Meanwhile, changing consumption patterns, such as increased demand for fruits and vegetables, many sourced from global markets, and a greater share of meals eaten outside the home increase our exposure to these risks as well. These developments challenge a creaking food-safety inspection system. Poultry production illustrates these dangers. Since 1960, production has increased from 1.5 billion to 8.6 billion birds slaughtered each year. Over the same period, average weight grew by 60 percent as the industry perfected methods to produce bigger birds faster and more cheaply. By the 1990s, chicken surpassed beef and pork in per capita pounds consumed.
To make money, producers must operate on a vast scale: Almost all chicken farms raise at least 100,000 broilers a year, and half of all sales come from farms that produce more than 600,000 birds annually. These concentrated poultry operations have become breeding grounds for dangerous bacteria, especially salmonella and Campylobacter. Moreover, the widespread use of antibiotics to promote animal growth—animals now consume 80 percent of all antibiotic drugs in the United States—has yielded new strains of these pathogens that are resistant to anti-microbial drugs. In August 2011, Cargill announced the recall of 36 million pounds of ground turkey contaminated with a drug-resistant strain of salmonella.
The development of more virulent bacteria due to concentrated animal production poses serious challenges to the system. Under the 1906 act (and additional legislation passed in 1957), every slaughterhouse in the United States must have inspectors present from the USDA to examine each animal and carcass for spoilage or disease. Historically, USDA inspectors relied on the “poke and sniff” method—using sight, touch, and smell to assess the quality and safety of meat. These techniques became woefully inadequate with the emergence of more virulent microscopic pathogens, such as E. coli O157:H7, a previously unknown strain of the bacterium that tragically sickened 700 people, killing four children, when they ate contaminated hamburger meat at a Jack in the Box fast-food restaurant in 1993. The event prompted the Clinton Administration and the USDA to require more sophisticated procedures to reduce pathogens like E. coli in the food supply. These methods, known as Hazard Analysis and Critical Control Point (HACCP), require food handlers to identify stages in the production process where the risks of contamination are highest and implement preventive measures that have the greatest effect on improving safety. The adoption of HACCP standards has led to measurable improvements in food safety as companies have invested in new technology that reduces the risk of contamination.
Big problems remain, however. There are two principal obstacles to effective food-safety control in the United States. First, food-safety regulations suffer from institutional fragmentation and administrative duplication that divide responsibility among multiple agencies in seemingly inexplicable ways. Recall that the Meat Inspection Act and the Pure Food and Drug Act split authority between the USDA, which is mainly responsible for slaughter and processing facilities, and the Food and Drug Administration (FDA), which is responsible for the overall safety of domestic and imported food products. Over the ensuing decades, authority fractured even further. In 1957, Congress passed a law expanding the authority of the Food Safety and Inspection Service (FSIS) in the USDA to oversee poultry production as well as beef, pork, and other meats. However, authority for egg inspection is governed by a different law, the Poultry Products Inspection Act of 1970, which divides authority between the USDA’s Agricultural Marketing Service and the FDA.
Similarly, responsibility for fish is divided between the FDA, which has primary responsibility, and the National Marine Fisheries Service of the Department of Commerce, which is also authorized to inspect and grade U.S. fish and shellfish. Altogether at least 12 federal departments and agencies operating under more than 30 different statutes have partial responsibility for food safety in the United States.
Some of the inefficiencies border on the absurd. Three agencies have authority over different aspects of egg production, processing, and transportation. Four agencies are responsible for monitoring and preventing “mad cow” disease. Five different agencies have responsibility for ensuring safe pizza, though which one depends on the topping: The FDA inspects facilities that produce cheese pizza, while the FSIS has responsibility for inspecting plants that make pepperoni pizza (and sausage, too). According to the Government Accountability Office (GAO), this fragmentation results in the inefficient use of resources, ineffective assessment of risk, and inconsistent inspection and enforcement. In fact, the GAO considers the need for comprehensive reform to be so great, and our food supply to be so vulnerable, that it designated food safety as a high-risk area in order to bring “needed attention to address the weaknesses caused by a fragmented system.”
Compounding the problem is the fact that responsibilities and resources are grossly mismatched. The FDA is responsible for 80 percent of the food we eat, yet the agency receives only 40 percent of the annual food-safety budget. Although federal rules require USDA inspectors to be present during the operation of slaughterhouses and meat-processing plants, no such requirement exists for other food-processing facilities that do not handle meat products. The USDA employs more than 7,000 inspectors and veterinary medical officers to staff 6,300 plants nationwide, which is good, but it is now looking to cut the number of federal poultry inspectors and to permit the industry to increase the speed at which it can process birds from 140 to 200 per minute. But at least the USDA can cover every plant. The FDA must divide its 2,500 inspectors and other field staff among 68,000 food production plants in the United States as well as monitor the rising tide of imported food. According to the Office of the Inspector General at the Department of Health and Human Services, the FDA inspects less than a quarter of facilities in any given year, and more than half of all the facilities in the United States have gone five or more years without a single inspection.
The second major obstacle to improving food safety is the limited enforcement powers among the major agencies involved. Legal maneuvering by the food industry has diminished the power of the USDA to enforce its own rules. In the case of pathogen reduction, for example, a lawsuit in 2000 by Supreme Beef Processors prevented the USDA from shutting down its plant after repeated tests indicated high levels of salmonella in its ground beef. A federal appeals court ruled that the USDA lacked enforcement authority because the new HACCP rules were outside the scope of the 1906 Meat Inspection Act, and therefore could not shut down a plant, even though it had repeatedly failed tests for salmonella contamination. Efforts to pass legislation that would give the USDA authority in such cases have repeatedly failed in Congress.
A Persistent Problem
One of the unforgettable moments in Food, Inc., the popular 2008 documentary on the food industry, is the tearful description by Barbara Kowalcyk of the painful last days of her two-year old son, Kevin, who was sickened by a hamburger contaminated with E. coli O157:H7. As he lay dying of kidney failure, Kevin begged his mother for a drink of water, unable to understand that liquids would only hasten his demise. It is impossible not to be moved by such a story, especially as a parent, and wonder how a product as seemingly harmless as a hamburger could kill a child.
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