First of three parts
MONDAY, Jan. 14, 2008 (HealthDay News) -- More than ever before, Americans are worried about the safety of the food they put in their mouths -- and with good reason.
In little less than a year and a half, the nationwide recalls of tainted products have formed their own peculiar food pyramid: meats, vegetables, salad, snacks, fast food, even dessert items. The various pathogens in those products killed at least three people, sickened more than 1,300 others and touched almost every state in the country as well as Canada.
And even though the number of outbreaks has leveled off over the last few years, it is the variety of outbreaks that most troubles the scientists and government health officials who deal with them: Many of the contaminations are showing up in foods never before associated with poisoning.
"It's been a little bit of a roller coaster the past 10 years," said Dr. Robert Tauxe, deputy director of the division of foodborne bacterial and mycotic diseases at the U.S. Centers for Disease Control and Prevention. "I am struck that I am seeing new food vehicles. New foods are a problem. Spinach was a new one. And peanut butter, there's a surprise. Also the Veggie Booty, or vegetarian snack food."
Not only are scientists puzzled about how such staples became tainted, but they are concerned that U.S. health officials need to do a better job of pinpointing potential sources of contamination before unsafe food winds up on supermarket shelves.
Such improvement in oversight won't come easily, experts noted.
The first obstacle, they said, is an agricultural industry that's becoming increasingly monopolized by a handful of high-volume producers, which means no contamination is small in size or scope.
Making matters worse, they added, is an outdated, imbalanced food-surveillance system that can't really police the nation's entire food supply.
And there's a lot to handle when it comes to food safety.
The number of outbreaks and cases of foodborne illness almost doubled in the United States between 1995 and 2000. In 1995, officials recorded 13,497 cases of food-related illness from 645 outbreaks; in 2000, there were 26,043 cases from 1,417 outbreaks. By 2005, however, the numbers had dipped a bit: There were 20,179 cases from 982 outbreaks.
But the types of outbreaks are now far more varied, due, in large part, to Americans' growing appetite for more raw fruits and vegetables, which can harbor dangerous bacteria.
Outbreaks of Listeria, a bacterium found in raw foods, have declined, while incidents of salmonella infection have stayed relatively flat. But infection with E. coli 0157:57, the dangerous bacteria that can show up in undercooked ground beef as well as dairy and vegetable products, which dropped dramatically in 2003 and 2004, is rising again -- and it's showing up in unexpected foods, such as spinach.
Fresh Produce Now the Focus
"One of the big issues of the day is fresh produce," said Michael Doyle, director of the Center for Food Safety at the University of Georgia, in Griffin. "Produce is where the action has been in the last few years, and there are a lot of reasons for it. One is a greater interest by consumers in eating fresh foods uncooked, and cooking serves a very important purpose of killing harmful bacteria."
"We've been consuming more produce, which is a good thing from a nutritional standpoint," he added. "But along with that, there have been issues with harmful microbes being present."
The cause of the E. coli outbreak in spinach that swept the nation in 2006 was never determined. However, the episode provided a glimpse into what can and does go wrong.
Increasingly today, produce is grown in fields close to cattle and, sometimes, wild animals. The E. coli spinach contamination could have come from cattle or boar feces, or from contaminated irrigation systems, federal officials concluded.
The widening of E. coli cases from protein products to fresh fruits and vegetables is related to "the fact that U.S. agricultural commodities tend to be grown in areas that have cattle, which are reservoirs for bacteria," explained Bruce Clark, a partner in the Seattle law firm of Marler Clark, which represents victims of food poisoning. "As soon as you have manure on the ground, and you have birds and wild animals and water, you have all these vectors for transferring bacteria to fresh fruits and vegetables."
And, most of the time, Clark added, produce is not subjected to the "kill step" (usually cooking), which would eliminate the pathogens. In fact, washing may not even help because of the ability of the organisms to cling to food surfaces.
Does Bigger Equal Safer?
The food safety issue is inescapably linked to the ongoing revolution in U.S. agriculture, with the emergence of mega-farms, mega-distribution centers and mega-transporters.
"Once you start to have larger and larger units and these bigger and bigger companies, any contamination incident automatically gets much worse by orders of magnitude," said Michael Hansen, a senior scientist with Consumers Union. "Before, it was just bad produce coming from one farm."
The problems are particularly pronounced in California, often called the nation's "salad bowl."
"Now we have this whole new question mark about leafy produce and the whole ecological question out there as we grow our leafy greens in the same area where more and more intensively we are producing milk," the CDC's Tauxe said. "Wisconsin used to be the biggest dairy state, and California was where we grew produce. Now California is both. And there's also wine production in California, so you have vineyards and cattle and lettuce patches competing for the same land and water. Agriculture is really sort of bumping into each other."
And problems can also arise after the produce has left the field. Today, it's more likely that one huge agri-business ships its product to processors who bag it under different labels and then distribute it to every state in the union.
The whole food production system has grown increasingly concentrated, overwhelmingly complex, and -- paradoxically -- at times fragmented.
At the same time, critics charge, U.S. government oversight is not adequate.
"Our real issue here comes down to appropriate oversight and regulation by our government agencies," said Mickey Parish, chairman of the department of nutrition and food science and acting chairman of the Center for Food Systems Security at the University of Maryland. "They have been cut back so severely in the last six to eight years that, quite frankly, it is more difficult to do the proper inspections that need to be done to ensure that the food is absolutely as safe as it possibly can be."
Both the U.S. Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) are charged with keeping the country's food supply safe. Yet the division of labor, and funding, between the two agencies shows where some of the problem may lie: The FDA receives 20 percent of the food safety budget, yet is responsible for 80 percent of the burden, while the USDA gets 80 percent of the budget for 20 percent of the responsibility. The USDA handles meat, poultry and certain egg products. The FDA handles everything else.
On top of that, according to Parish and Hansen, the FDA has about one-tenth of the number of inspectors as the USDA does and has actually reduced the number of produce inspectors it employs.
Some estimates suggest there are 12 percent fewer FDA employees in field offices who concentrate on food issues, with safety tests for domestically produced foods down almost 75 percent -- from 9,748 in 2003 to 2,455 in 2006.
"The FDA doesn't have anything like continuous oversight," Parish said. "The FSIS [Food Safety and Inspection Service, part of the USDA], on the other hand, has continuous oversight where an inspector has to physically be at the plant at least during part of the day."
Despite mounting criticism, federal regulators steadfastly defend their record.
"I think the agency is doing an excellent job, given the resource challenges," said Michael Rogers, director of the Office of Field Investigations at the FDA. "I would compare our track record to anyone's."
What about overlaps with the USDA?
"Both agencies have a major role to play with respect to public health protection," Rogers said. "I don't know that moving around boxes [shuffling responsibilities between agencies] is a starting point for discussion."
"I don't see redundancy as a negative," he added. "I can't see downsides to redundancies and some overlaps in responsibilities and regulations if it results in additional oversight and regulation for that industry."
A Patchwork of Responsibilities
Consider the peculiar way that federal oversight can work.
The FDA monitors the safety of frozen pizza -- unless that pizza has a pepperoni topping. Then the USDA takes over, according to a 2005 U.S. Government Accountability Office report.
The amount of a particular ingredient in a can of soup dictates whether that soup falls under the purview of the USDA or the FDA. If a canning facility produces soup containing meat or poultry, it is inspected daily by the USDA. But if the plant also produces soup containing beans or seafood, then the FDA inspects it every one to five years.
"As economies have developed, and there are more commercial food manufacturers and multi-ingredient products, there have been some overlaps" between the USDA and FDA, said Jessica Milano, a Washington, D.C.-based consultant who wrote a report on food safety for the nonprofit Progressive Policy Institute. "There's a big gap in how things are being inspected, which becomes more ridiculous when you look at products like cheese pizza, which isn't getting inspected that frequently, but pepperoni pizza is."
Mark Garrison, editor of healthinspections.com, which focuses on restaurant safety, said: "You also have so many jurisdictions across counties and cities, which have vastly different food codes in terms of handling in restaurants. Is that a significant problem? It's hard to say. There are some jurisdictions that let restaurant food workers handle food without gloves and some that don't. Then you have the FDA proffering a model food code to jurisdictions, and some use it and some ignore it. There's a lot of difference in how even individual municipalities regulate."
Yet, in the end, even critics admit that, overall, the U.S. food system is relatively safe.
"If you look at all the volume of food that comes in from the outside plus what we produce internally, we still have a very safe food supply, possibly one of the safest in the history of mankind, quite honestly," said Parish. "But there have been some very high-profile problems that have popped up in past few years that have thrown fairly bad light on the system."
Added Doyle: "I think our food supply is still safe."
NEXT: The Growing Threat of Imported Products