Second of three parts
TUESDAY, Jan. 15, 2008 (HealthDay News) -- One Sunday after church, Rich Miller headed to a local Chi-Chi's restaurant in Beaver, Pa., where he dipped into the house salsa that came with the meal.
That simple act in 2003 changed his life forever. What Miller didn't know was that imported Mexican green onions in the salsa carried a deadly passenger: hepatitis A.
A few days later, as Miller recalled recently, "I couldn't even get out of bed. It was like the worst case of flu that you could ever imagine."
His health quickly deteriorating, the 57-year-old railroad superintendent was diagnosed with rare fulminant hepatitis A disease -- in which the virus destroys the liver -- and was rushed to a Pittsburgh hospital for a liver transplant.
Placed in a medically induced coma for a month, Miller eventually returned home, frail and unable to return to work. To this day, he said, he has mobility problems and neurological difficulties.
Still, Miller considers himself lucky: Four others who ate the salsa and developed fulminant liver illness died. Overall, more than 600 people around Pittsburgh were sickened during what became the largest hepatitis A outbreak in U.S. history.
The story is just one of many over the past few years that have swung the spotlight on the dangers of imported foods, which now comprise 13 percent of the American diet, according to the U.S. Department of Agriculture.
Perhaps the most high-profile examples of these potential dangers come from last year's tainted pet food scandal and the halting of questionable food products from China.
The pet food disaster, which slowly evolved into the largest recall of pet food in U.S. history, involved exported wheat gluten from China that contained the toxic chemical melamine and was used as an additive in food sold under more than 100 brand names. Hundreds of dogs and cats died; an official tally was never issued. In addition, U.S. health officials disclosed that up to 3 million broiler chickens had been fed the contaminated surplus pet food and then had been sold to restaurants and supermarkets across the country.
That was followed by a recall of almost a million tubes of toothpaste from China that were contaminated with a chemical used in antifreeze. The toothpaste had been distributed to institutions for the mentally ill, hospitals and prisons in the South.
And, shortly after that, U.S. health officials detained shipments of farmed fish from China pending additional testing for chemical residues before allowing them into the U.S. marketplace.
But China is not alone in triggering American foodborne woes.
Last year also, a salmonella outbreak caused Dole Fresh Fruit Co. to recall roughly 6,104 cartons of imported cantaloupes from Costa Rica that were distributed to wholesalers in the eastern United States and Quebec. There were no reports of illness.
But in 2006, an outbreak of nonfatal scombroid fish poisoning linked to tuna steaks imported from Vietnam and Indonesia sickened 15 people in Louisiana and Tennessee. And a 2001 outbreak of salmonella in Mexican cantaloupes killed two people and sickened 25 others across 15 states.
In November, officials at the U.S. Food and Drug Administration reacted to the newest outbreaks with a sweeping set of proposals dubbed the Food Protection Plan. It calls for legislation that would give the agency broader powers (including mandatory food recall), heftier financing, and improved cooperation with producers, importers and foreign governments to stop tainted food at the source. The plan remains just that, however, pending Congressional action.
Still, "I think it's clearly a step forward," said Bill Hubbard, who spent 14 years as associate commissioner of the FDA before retiring in 2005. Hubbard, who is now an adviser for the Washington, D.C.-based consumer advocacy group Coalition for a Stronger FDA, said, "The plan is clearly an attempt to change the paradigm from 'inspect only at the border' to putting more of the responsibility elsewhere," especially at the source of production abroad.
"Put in place procedures where you say to the importer you need to be checking on your supplier, then the exporter in China is supposed to be looking at his supplier and then all the way back to the producer," Hubbard explained. "Everybody is checking on everybody and keeping records. And, in theory, that can work. But the FDA will need new statutory authority to oversee something like that, and resources."
The full scope of the problem remains unclear, however.
Food safety experts stress that it's almost impossible to sort out whether the thousands of smaller food-linked disease outbreaks that occur each year in the United States are attributable to domestic or imported product. According to the U.S. Centers for Disease Control and Prevention, about 76 million cases of food-related illness are reported in the United States each year, including 5,000 deaths.
More Contaminants in Imported Foods
One thing is clear: You're more likely to encounter contaminants in foods from abroad than those grown in the United States.
According to a FDA report released in 2003, pesticide violations were cited in 6.1 percent of imported foods sampled versus 2.4 percent of domestic products. And a report issued by the agency a few years earlier found traces of salmonella or the dysentery-linked bacteria shigella in 4 percent of imported fruits and vegetables versus 1.1 percent of domestic produce.
And there's more imported food in the nation's supermarkets than ever before. According to the CDC, food imports to the United States have almost doubled in the past decade, from $36 billion in 1997 to more than $70 billion in 2007.
Trouble is, inspections by the FDA -- either at the source of production or at the borders -- can't keep up. The agency is responsible for inspecting all imported foods with the exception of meat and egg products, which are covered by the Food Safety and Inspection Service, part of the U.S. Department of Agriculture.
Overall, "there's been an 81 percent drop [in FDA inspections] since 1972," noted Michael Doyle, director of the Center for Food Safety at the University of Georgia, in Griffin. "That's a huge reduction, and, at the same time, compared to 1972, we have a huge amount more of food imports."
In fact, the FDA's own data show that the number of inspectors at its Office of Regulatory Affairs dropped from 1,642 in 2003 to 1,389 in 2005 -- even as food imports rose from 9.3 million shipments per year to more than 13.8 million shipments annually.
The reason for the shortfall is simple, Doyle said: "Reduced budgets."
The bottom line, according to FDA figures, is that its inspectors now sample just 1.3 percent of all imported food shipments entering the country.
However, simply boosting the number of inspectors may not be the solution, said Michael Rogers, who helps oversee FDA foreign and domestic inspections as director of the FDA's division of field investigations.
"With more [money], certainly more inspections can be done," he said, "but that's not the panacea for total public heath protection." Instead , Rogers said, collaborating with business and foreign governments to help spot tainted food before it reaches this country, which is part of the Food Protection Plan, may be the most important step the agency can take.
Certainly, the agency currently performs relatively few on-site inspections of foreign farms and food processing plants.
The farm in Ojos Negros, Mexico, that was the source of the 2003 green onion contamination had never been inspected by U.S. authorities before the incident. And the FDA inspection that took place soon after the outbreak makes for chilling reading.
In their report, filed in December 2003, agency inspectors said they observed dirty runoff from the farm workers' windowless, mud-floored shacks and crude showers seeping directly onto fields where produce was grown. Photos of the site "show evidence of soiled diapers, soiled feminine hygiene products, and domestic waste" lying nearby, according to the report.
The growing fields were irrigated with water from a pond that was also a dumping ground for human sewage and animal manure. During processing, green onions typically passed through the hands of at least six workers, the FDA team said, and there was no evidence that workers were allowed time off for illness. While the firm purported to wash all onions in chlorinated water, it could produce no evidence to back that claim.
The Problem With China
The Chi-Chi's outbreak has been just one of many, and, in 2007, the focus shifted from Mexico to China.
The pet food scandal, as well as a stream of toy and other recalls in 2007, spurred negotiations between U.S. officials and their counterparts in China, which exported $4.2 billion worth of food to America last year -- much of it in the form of ubiquitous processed food ingredients such as wheat gluten or ascorbic acid.
While no major outbreaks of human foodborne illness tied to Chinese products have occurred recently, they're not unlikely in the future, Hubbard said. Much of the food in China that's destined for U.S. dinner tables is grown and processed by mom-and-pop producers with little or no oversight, he said.
"What they've got is this vast cottage industry of producers making this stuff. Sometimes you might have a producer making just five or six sacks of flour per week in the hinterlands of China," Hubbard said. "China experts tell me that the central government in Beijing has very little influence out in the countryside where this is made."
China has reacted recently to international pressure by signaling that it is ready to tighten food safety standards. In December, the United States and China signed an agreement that places new registration and inspection requirements on 10 food products exported by Chinese companies. The products include some preserved foods, pet foods and farm-raised fish, all of which have come under suspicion of being tainted.
Those types of market reactions may help fix things in countries of origin such as China, experts say, but weaknesses remain here at home.
Topping the list: a chronic underfunding of FDA inspection services, according to critics. "If you look at the Bush Administration's fiscal year 2007 budget proposal, the Produce Safety and other food programs are going to be cut by $22.6 million from 2006 levels, and the staffing would be reduced by 105 full-time employees," Doyle noted.
One private industry food safety inspector, Ed Sherwin, said he doesn't blame management or workers at the FDA for what he considers to be poor oversight of imported foods.
"What I've found is that the federal inspectors from FDA and USDA are excellent in their work, but they are understaffed and overworked," Sherwin testified at a special Congressional hearing on the issue in October. In the meantime, "profits take priority over food safety," Sherwin said. "Food service operators tend to rely on their suppliers to provide the products that best meet their needs at the lowest price. Operators don't care if the crabmeat is from Maryland or Malaysia, the grapes are from California or Chile."
Lack of 'Traceability'
Inspections at the border and ports of entry can help spot trouble, but experts say the FDA currently has full-time inspectors in place at just 90 of the nation's 300 import points of entry.
Then there's what's known as "port shopping," where shoddy goods are moved from one port to the next until they can be slipped past inspectors.
"Importers know that if FDA only looks at 1 percent, then even if they get caught at port A, chances are they won't get caught at port B," Hubbard explained. "Or they'll sometimes use things like inland ports for seafood. Shippers will enter their food through Las Vegas, where's there's no [FDA] seafood person, because it's an inland port."
Testifying at the congressional hearing, Caroline DeWaal, of the Center for Science in the Public Interest, said imported food is often hard to track once it gets by port inspectors. "For example, with produce, it can all go into the same warehouse," she said. As part of normal distribution, she added, "they can mix boxes, and produce from several different countries can be reshipped out again without any kind of labeling."
This lack of "traceability" can make it tough to uncover the source of an outbreak and can cause worried consumers to avoid all brands of a given food, severely affecting an entire industry.
That scenario unfolded in the early days of the 2006 U.S. spinach scare, experts noted, with consumers simply avoiding the leafy green altogether, regardless of where it was grown.
Finally, there's the problem of what everyone calls the FDA's lack of clout in punishing companies that import dangerous foods. The agency is allowed by law to recall dangerous pharmaceuticals, but it has no such power over potentially deadly foods. The new Food Protection Plan does include a provision calling for mandatory recall authority, but it remains to be seen if legislators will grant the agency those new powers.
Moves toward more thorough and frequent inspections offer little comfort to food-poisoning victims such as Miller, who reached an out-of-court settlement of his lawsuit against Chi-Chi's before the company went out of business in the United States in 2004.
Miller said his story should remind Americans just how close the link is between what's on their forks and what's in fields thousands of miles away.
"Disease knows no boundaries," he said. "I know that we are still going to have outbreaks -- nothing is perfect, and you can't stop everything. But we have to lessen it, and lessen its impact."
NEXT: Can Food Safety Problems Be Solved?