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The FDA Lacks the Resources to Ensure the Safety of America's Food Supply
Source of Article:
By: Dr. Val | February 11, 2009
The recent peanut butter/salmonella outbreak offers another opportunity to reflect on the underlying budget crisis and staff shortage at the Food and Drug Administration. I interviewed Tommy Thompson, former Secretary of Health and Human Services, about what the peanut butter debacle tells us about the FDA inspections of our food supply.
Dr. Val: Has this recent outbreak influenced how the FDA tracks food ingredients?
Thompson: No it hasn¡¯t. We have a serious food problem in America because the FDA is understaffed. There have been too many outbreaks of food poisoning ? everything from listeria on cucumbers and onions to salmonella infections from ice cream and peanut butter. Approximately 82 million people experience an episode of food poisoning each year, 350,000 of them require treatment in a hospital and 8,000 die. People don¡¯t seem to realize what a large problem food poisoning is until there is a new outbreak. The recent peanut butter contamination affected between 700-800 different food products.
Americans need to realize that the FDA is severely understaffed and cannot do the inspections necessary to protect all of our food. I¡¯ve been harping about this for a long time. When I was Secretary of HHS I was able to increase the number of inspectors by 100%, but since I left, the funding was decreased and the numbers of inspectors is back to the level when I started.
There are 64,000 venues that the FDA has to inspect, and there are only 700 inspectors. It is geographically and mathematically impossible to do all the inspections. The FDA is responsible for inspecting 80% of our food supply while the department of agriculture does the rest. The department of agriculture has 7,000 employees and 6,000 venues that they have to inspect. Just compare the resource differential between the FDA and the department of agriculture and you see the serious constraints under which the FDA operates.
The department of agriculture inspects every meat processing factory every day. But an FDA inspector may get to a food processing plant only once every 6 or 7 years.
Dr. Val: Wow, that¡¯s enlightening and also terrifying at the same time.
Thompson: Yes, it really is. We inspect less than 1% of the food coming into America. The amount of imported food continues to increase as the number of inspectors decreases. We have some serious problems with our food supply and it¡¯s about time that Congress recognized this
The FDA is doing the best job they can, and yet they are regularly criticized by the media. When you consider their limitations, they¡¯re doing a heck of a good job with the resources they have.
Dr. Val: So what do we need to do to improve this situation?
Thompson: The FDA needs a larger budget, we need to get more inspectors out there, we need updated testing technology, but we also need a more modern law that would require food processing plants to file an affidavit with the FDA to ensure that their food is safe. There¡¯s very little supervision of these companies.

Dr. Val: Is there anything the public can do to petition the government to increase funding to the FDA so they can inspect our food properly?
Thompson: There¡¯s a coalition to improve the quality of food inspections at FDA and I¡¯m a part of that. There are people in Congress who are working on introducing legislation to provide the FDA the resources necessary to hire more inspectors, and to require affidavits of safety from food processing plants.

Dr. Val: Do you think Dr. Joshua Sharfstein will become the new FDA commissioner?
Thompson: Sharfstein is being considered for a position at FDA, whether it¡¯s commissioner, assistant commissioner, or chief of staff I don¡¯t know.

Dr. Val: Do you have any advice for the new FDA commissioner, whoever it is?
Thompson: Yes. In addition to lobbying for increased funding to support more inspector positions, he or she should consider appointing a special commissioner of food that would report directly to the Secretary of Health and Human Services. The new FDA commissioner should focus on getting medicines and new drugs to market. In 2008 we had fewer new drugs get to market than any year since 1981. The entire FDA is overworked, the responsibilities are great, and congress meddles too much in their affairs, though that may change now that the democrats control both houses and the presidency.
The staff at FDA are becoming demoralized because every time they make a decision someone in congress criticizes them for it. Then they become reluctant to make decisions at all.

¡°The Market For Peanuts: Why Food In The U.S. May Never Be Safe¡±
Source of Article:
In the ongoing political (and legal, and historical, and economic) arguments about the regulation of social and economic activity by governments and government agencies, one of the dominant theoretical controversies has been over the answer to this question: Do regulations ¡°interfere¡± with the market-place by creating unnecessary inefficiencies and higher costs, or are regulations a necessary corrective for the inevitable ¡°failures¡± of an unregulated (or ¡°free¡±) market? While this controversy remains justifiably open in the context of the markets for many products and services?e.g., transportation and energy, there is no rational justification for an argument in favor of a ¡°free¡± market for food.
To begin with, there is no such thing as a ¡°free¡± market for food because such a market is defined by an almost perfect asymmetry of information. In other words, when it comes to the safety of the food being considered for purchase, the manufacturer and seller knows the relative care that went into production, but the buyer purchases the product based mostly on trust. The inability of consumers to discern the relative safety of their food purchases limits all but a generalized demand for safer food. This is because:
For the most part, food safety is a credence attribute, meaning the consumers cannot evaluate the existence or quality of the attribute before purchase, or even after they have consumed [it].
This generalized demand for safer food, which is applicable to an entire industry or product-category, is thus ineffective in causing the market to enhance food safety. As a result, there is little economic incentive for producers to manufacture food that is safer than that which is required by government regulations. Such regulations therefore tend to act as a ceiling not a floor, and effectively suppress most competition in the realm of food safety. In economic terms, the regulations thus act as a ¡°negative incentive¡± that prompts a manufacturer to invest what is necessary to avoid non-compliance, but nothing more.
In the case of the Peanut Corporation of America (PCA), you can perfectly see this dynamic in work. Faced with infrequent and ineffective inspections, PCA was free to do what it wanted in its pursuit of higher profits. This included, according this week¡¯s article in the New York Times, Michael Moss, Peanut Case Shows Holes in Safety Net, Feb. 9, 2009.
The conditions at the plant, more circa 1955 than 2009, would have been enough to cause alarm in an industry where sanitation can be a matter of life and death, food experts said.
* * *
But its yellow-brick walls hid the array of poor work conditions and safety flaws, said employees, who lost their jobs when the plant closed on Jan. 16.
Many of the hourly workers earned only minimum wage and had gone years without a raise. Frederic McClendon, 31, a shift supervisor, reached $12 an hour last year but still could not afford health insurance for his two boys, who live in a weather-beaten trailer. ¡°If you pay your workers, you get the best out of them,¡± Mr. McClendon said. ¡°If you don¡¯t, you don¡¯t.¡±
Using temporary workers also saved money, said Mr. Hardrick, the assistant manager, ¡°but there was a lot of retraining going on.¡±
But should any of this be a surprise to anyone? What was the incentive to invest in modernizing the plant, in employee training, and in vigorous internal oversight? There was none, except for the risk that the shocking problem would somehow come to light. And they did not. For years.
In the ironic words of Henry Waxman, D-Calif, words that were not, by the way, intended to be ironic, he asserts that the company's internal records show it "was more concerned with its bottom line than the safety of its customers." What a shock!

But none of this is intended to suggest that updated regulations and increased enforcement will, by themselves, be enough to create an effective market for safe food. The existence of regulations can be just as much a problem as no regulations at all. Rather than worrying about a competitor doing more to improve the relative safety of a product-category?e.g., like bagged fresh produce?regulations can impose a predictable cost that companies can meet, but need not exceed. Thus, even though certain spinach growers had invested far more than others before the 2006 Dole spinach outbreak occurred, the outbreak hurt the market as a whole. The same thing also occurred in 2003 when the price of boxed green onions dropped in one week from $18.30 to $7.23 per box in reaction to the widespread outbreak of hepatitis A infections linked to contaminated green onions used at a Mexican restaurant in Pennsylvania.

Nonetheless, in the wake of the 2006 spinach outbreak, the fresh leafy green industry actively sought regulation, albeit on a quasi-permissive basis. Sensing that certain competitors had already invested in many of the food safety improvements that proposed regulations might require, and that the food-safety bar might be set too high, the green leafy produce industry drafted marketing agreements that would put in place a set of minimum requirements that all market-participants would have to meet to sell their produce. It is notable that the minimum requirements were far less stringent than what one major market-participant already had in place. For example, in one article examining the changes it was noted:
Fresh Express requires an 800-foot buffer between fields of leafy greens and pastures and one-mile buffers between leafy greens and feed lots. "The (leafy greens) metrics could do better, but they certainly set a floor," says Jim Lugg, food-safety chief for Fresh Express.
And so no one should be surprised, that in the case of peanuts, the State of Georgia hopped right to it in tightening the regulation of this important agricultural commodity. Thus, according to an AP Article published today:
A sweeping new food safety measure proposed in the wake of the salmonella outbreak easily passed its first key legislative hurdle Wednesday as Georgia lawmakers sought to reassure antsy residents.
The Senate Agriculture Committee unanimously approved a plan that would require food makers to alert state inspectors within 24 hours if a plant's internal tests show its products are contaminated.
This may all be well and good, but do not misunderstand the real intent here is not to protect the public, it is to protect the peanut industry (from itself). Since the PCA Salmonella outbreak, the sales of jars of peanut butter have dropped 22%, and the spot-price for peanuts is down as much.
But by enacting regulations that mostly rely on self-reporting, the State of Georgia, is aggressively setting the safety bar lower, and potentially heading-off more stringent requirements that might be imposed on a national level. This ultimately will have the effect of leveling the playing field for the rest of the market, and ensuring that all will bear similarly low costs in meeting the ¡°strengthened¡± safety requirements. While a good public-relations maneuver, this is, in fact, a strongly anti-competitive move that may create a set of safety requirements that are less stringent than what would have likely resulted if market participants had been forced to compete in an open market for safety. And this suppression of higher quality standards is also precisely what the Nobel prize-winning economist George Akerlof predicted in his seminal article ¡°The Market for Lemons,¡± in which he states:
there is an incentive to for sellers to market poor quality merchandise since the returns for good quality accrue mainly to the entire group¡¦rather than to the individual seller.
In other words, if everyone in an industry pays to the same extent when unsafe or poor quality goods are sold, a greater profit can be made by competing on price not quality, so long as the consumer cannot tell the difference. Such is the case with food products, and thus it remains the public that pays the highest cost for foodborne illness each year.
Finally, there is the important issue of traceability?or, in the case of the United States, the stunning lack of it. In a market where the suppliers of commodities can safely assume that the likelihood of being held responsible is small, and the profit potential of taking the small risk of being caught is high, then no one other than the completely naive or disingenuous should be surprised by the emails that were yesterday revealed to have been sent by the president and CEO of Peanut Corporation of America, including the one where he directed that contaminated product be shipped?¡°turn them loose¡±?and where he wrote in a June 2008 e-mail, "I go thru this about once a week. I will hold my breath .... again." Well, apparently Mr. Parnell never had to hold his breath very long, because he could breathe easy about not being caught?that is until his product managed to sicken and kill enough people to make it impossible not to trace the problem back to him and his indefensibly awful operation.
Of course, the chorus of anti-regulation zealots has already sprang into action, declaring PCA an aberration instead of a case-study. But, at this point, after outbreak after outbreak after outbreak, is it possible that finally, once and for all, the case for the effective regulation of the food industry has been incontestably made? I can only hope so. Because until the market for peanuts?and other food?is made to work for the benefit of the public health, the big profits will continue to go to the companies that cheat, cut corners, and do not care.

CDC's Role During Foodborne Outbreaks
Source of Article:
Written by Imperial Valley News
Monday, 09 February 2009
Atlanta, Georgia - There are a lot of players that have different roles in the food safety system in this country. CDC¡Çs role is non-regulatory, which means we don't regulate food or industries.
Most foodborne outbreaks are identified and investigated by local and state health departments. CDC provides consultation on some of those, as well as assistance on request for outbreaks that are particularly large, unusual, or severe. During a multi?state foodborne disease outbreak, CDC serves as lead coordinator between public health partners to detect the outbreak, define its size and extent, and to identify the source.
Specifically, we monitor surveillance for a number of foodborne infections. We also assist states in their investigations. When it¡Çs a large nationwide foodborne outbreak we will lead the investigation to assist in finding the source. We think it¡Çs very important find and identify the problem, the root cause of an outbreak, to prevent future and further illness so that we all can learn from what went wrong.
In recent years, large multi-state foodborne outbreaks have become more common, because better surveillance identifies outbreaks that would previously have been missed and because an increasingly centralized food supply means that a food contaminated in production can be rapidly shipped to many states causing a widespread outbreak.
CDC collaborates with regulators like the U.S. Food and Drug Administration, the United States Department of Agriculture, the Environmental Protection Agency, and state health departments to provide our expertise, information, and tools that people and communities need to protect their health.
CDC maintains and monitors several disease surveillance and outbreak detection systems in collaboration with public health partners. PulseNet, a sophisticated outbreak detection system, is a national surveillance network of CDC, state, and local public health laboratories and federal food regulatory agency laboratories. PulseNet performs pulsed-field gel electrophoresis (¡°DNA fingerprinting¡±) on disease-causing bacteria that may be foodborne to find clusters of cases that might be related.
Once a potential multi-state outbreak has been detected, CDC¡Çs OutbreakNet Team engages to investigate it. By collaborating with public health partners, OutbreakNet leads the epidemiologic investigation of multistate outbreaks. OutbreakNet coordinates communications among states and may lead epidemiologic studies. These are studies to develop a short list of suspect foods or other exposures (¡°hypothesis generation¡±), to identify food exposure associated with illness(¡°case control studies¡±), and to determine how the food became contaminated. CDC also provides assistance in the field to any state requesting it. CDC¡Çs laboratories maintain PulseNet surveillance to identify new cases, conduct advanced laboratory tests of disease-causing microbes, test suspect foods, and provide technical support to OutbreakNet and public health partners as part of the investigation.

Once a contaminated food source has been identified, public health action to control the outbreak can be taken by regulatory agencies such as FDA and USDA/FSIS. At this stage, CDC continues to investigate potential sources of illness and monitors for additional illnesses to determine when the outbreak is over. CDC also advises the public about what they can do to protect themselves, advises the medical community about how to treat the infections, and works closely with the regulatory agencies and industry to learn how to prevent similar outbreaks in the future

Fresh Fruits And Vegetables Are Increasingly Recognized As A Source Of Food Poisoning Outbreaks
Source of Article:
ScienceDaily (Feb. 13, 2009) ? Raw fruits and vegetables are good for you but may also send you to the doctor, according to research published today by Cambridge University Press in the journal Epidemiology and Infection.
A review article in the journal, written by several experts in their field, has highlighted the fact that fresh fruits and vegetables are increasingly recognised as a source of food poisoning outbreaks in many parts of the world.
In Europe, recent outbreaks have revealed new and unexplained links between some bacterias and viruses that cause food poisoning and imported baby corn, lettuces, and even raspberries. In the USA, recent outbreaks of E Coli infections have been linked to bagged baby spinach, and Salmonella to peppers, imported cantaloupe melons and tomatoes as well.
Professor Norman Noah, Editor-in-Chief of the journal says: "This research confirms that raw fruit and vegetables can cause food poisoning. To obtain raw fruit and vegetables out of season, as many countries now do, they are transported many thousands of miles from growing areas, and outbreaks can affect many widely dispersed countries simultaneously. Some outbreaks undoubtedly go unrecognized, and the scale of the problem is as yet unknown.
"Identifying the source of contamination in any outbreak requires a careful assessment of potential exposures. Further work needs to be done to fully understand fully where the organisms that causes the poisoning comes from, and at which point in the journey from field to fork."
In the journal, the links between raw produce and food poisoning have been compared with other foods that are now well-recognized sources of infection with particular bacteria, such as eggs with salmonella and beef mince with E Coli.

The real impact of the Salmonella outbreak
Source of Article:
According to an article in USA Today, with the number of recalled products linked to the current Salmonella outbreak jumping to 1,700, it¡¯s likely that the health risks may reach far beyond the 538 reported illnesses. In fact, according to previous research by the Centers for Disease Control and Prevention (CDC), for each case of salmonellosis that is reported, more than 38 other people get sick. This could mean that the outbreak is responsible for more than 20,000 illnesses.
In addition, the large number of recalled products is having an effect on consumers¡¯ purchasing behavior. It seems that some consumers are avoiding all peanut butter products, including jarred peanut butter, even though leading brands have not been affected by the outbreak. According to an article in Daily Press, figures from The Nielsen Co. report that jarred peanut butter sales during the four weeks ending Jan. 24 dropped 22% from the same period the previous year. To fight the sales slump, the makers of Jif and Peter Pan have countered with a costly advertising campaign aimed at reassuring consumers.
The outbreak is also impacting the Food and Drug Administration, as people begin to question the effectiveness of the agency¡¯s food safety measures. It also is a wake-up call to the food industry in general. Any manufacturer who produces products containing nut butter is questioning the ¡°kill step¡±?the step that kills Salmonella bacteria?in their manufacturing processes. ¡°If there¡¯s anybody out there in the industry who¡¯s manufacturing nuts or nut butter of any kind, they really need to get on the stick and study the thermal processes they¡¯re using and document that it¡¯s effective against Salmonella,¡± said Donald Schaffner, Food Microbiologist and Member of the Institute of Food Technologists.
The Peanut Corp. of America (PCA), the origin of the peanut products that contain the Salmonella strain causing the illness, is under a criminal investigation by the FDA and the Justice Dept. A second congressional hearing on the recall is scheduled for Feb. 11. According to the article, the FBI executed search warrants at the PCA plant in Georgia and the Lynchburg, Va. headquarters on Feb. 9.

Oregon family tells Congress about boy's salmonella poisoning
Source of Article:
, 2009, 9:21 PM
J. Scott Applewhite/The Associated PressNow healthy, Jacob Hurley, 3, waves at lawmakers during a hearing Wednesday on Capitol Hill into the salmonella-tainted peanut product that made him seriously ill. The Oregon boy is one of about 600 people nationwide sickened in the food-contamination scandal.
WASHINGTON -- In testimony that was both riveting and unnerving, a father from Oregon told a House subcommittee Wednesday how salmonella-laced peanut products "poisoned" his 3-year-old son.
Peter Hurley, a 40-year-old officer with the Portland Police Bureau, told the House Commerce Subcommittee on Oversight and Investigations that his son, Jacob, became seriously ill last month, a victim of one of the worst cases of food contamination in a generation.
Also appearing before the subcommittee was Stewart Parnell, owner of the Peanut Corp. of America, blamed for the salmonella outbreak. E-mails released by the committee showed that the company's senior managers did not wait for lab results before shipping a load of peanut product that tested positive for salmonella.
Each time he was asked a question, Parnell invoked his constitutional right not to incriminate himself. He even used the privilege when asked if he had heard the stories from Hurley and two families from Minnesota whose mother and father died from salmonella poisoning.
Parnell's silence after the wrenching testimony focused lawmakers' anger and sparked their promises to reform a food safety system they said is disjointed, riddled with loopholes and lacking tough penalties. The behavior of Peanut Corp., lawmakers said, illustrates the ease with which violators can avoid detection and heavy penalties, including weaknesses that allow producers to "lab shop" for results.
¡í Salem company joins recall list
"Today's hearing will examine how this contamination was allowed to grow unchecked and the collective failure of multiple layers -- the peanut butter manufacturer, the Food and Drug Administration, state regulators and private industry," said the subcommittee chairman, Rep. Bart Stupak, D-Mich.
The human costs of those failures became immediately clear as Hurley testified.
Jacob began vomiting and having diarrhea, Hurley told the committee. "He was sallow, lethargic. ... In a few days he began to have blood in his diarrhea."
The pediatrician diagnosed salmonella poisoning and told the Hurleys to feed Jacob "his favorite comfort food" if he became hungry. So Hurley and his wife gave Jacob his favorite snack, Austin Toasty Crackers with Peanut Butter.
The crackers contained peanut products from Peanut Corp., which federal officials have linked to a salmonella outbreak that has sickened about 600 people and triggered a recall of 1,800 products ranging from cookies to ice cream to dog food.
Officials believe the salmonella-laden products from the plant are now responsible for nine deaths after Ohio health officials announced Wednesday that an elderly woman who died earlier this year had been infected with the strain involved.
And records released by the subcommittee showed that the plant in Georgia had 12 positive tests for salmonella in 2007 and 2008.
But at the time the Hurleys served the crackers to their suffering son, those details weren't known.
They gave him the crackers -- "the very food that we later found was the cause of his poisoning," Hurley said.
A week later, the family learned that the crackers contained salmonella. William Keene, a state epidemiologist, came to their house and collected food, including six packages of Austin crackers. Three tested positive.
Jacob's story ends happily. He recovered and attended the hearing with his parents and two sisters.
The other witnesses were not so fortunate.
Jeffery Almer and Lou Tousignant, both of Minnesota, told the committee how their mother and father, respectively, died after eating contaminated peanut products from the plant in Georgia.
Almer said his mother survived cancer and was planning for the future. "Cancer couldn't claim her," he said, "but peanut butter did."
While the hearing exposed flaws in the government's response, most of the anger was directed at Peanut Corp.
When a lab official informed a Peanut Corp. plant manager of a positive salmonella test, he said, "Uh-oh," adding that the contaminated food was already on a truck to Utah.
In mid-January, after the national outbreak was tied to his company, Parnell, the owner, told FDA officials that his workers "desperately at least need to turn the raw peanuts on our floor into money." In another exchange, he told his plant manager to "turn them loose" after products deemed contaminated were cleared in a second test.
Parnell's response to a final lab test last year showing salmonella was about how much the problem would cost and the impact that lab testing was having on moving his products.
In an Oct. 6 e-mail to Sammy Lightsey, his plant manager, Parnell said time for the testing "is costing us huge $$$$$$ and causing obviously a huge lapse in time from the time we pick up peanuts until the time we can invoice."
Almer expressed a sentiment that lawmakers seemed to share.
"Their behavior is criminal, in my opinion. I want to see jail time," said Almer, whose 72-year-old mother died Dec. 21.
"I want to see them served nothing but the putrid sludge they've been dealing out," he said, adding that the company "now has the blood of eight victims on their hands, along with the shattered health of a known 600 others."
Oregon Rep. Greg Walden, the subcommittee's ranking Republican, brought a bucket of recalled products to the hearing. It was wrapped in police tape.
Parnell sat stiffly, his hands folded in his lap at the witness table, as Walden held up the jar and asked Parnell if he would be willing to eat the food.
"Mr. Chairman and members of the committee," Parnell said, "on advice of my counsel, I respectively decline to answer your questions based on the protections afforded me under the U.S. Constitution."
After repeating the statement several times, he was dismissed from the hearing.

Peanut Corp shuts Texas plant in salmonella scare
Tue Feb 10, 2009 2:09pm EST
Source of Article:
By Ed Stoddard
DALLAS (Reuters) - Peanut Corp of America, at the center of a nationwide salmonella scare, has shut its Texas plant after tests showed possible contamination in some of its products, health officials said on Tuesday.
One of the company's plants in Georgia has been identified as the source of food poisoning that has sickened at least 600 people in 44 states and Canada, more than half of them children, and may be linked to eight deaths.
The salmonella outbreak has forced one of the biggest recalls in U.S. history, involving more than 1,800 products ranging from snacks and ice cream to dog treats.
The Texas Department of State Health Services said Peanut Corp voluntarily closed its Plainview facility on Monday evening "after laboratory tests of sample products from the plant indicated the possible presence of salmonella in some."
"It does not appear that any of the implicated products -- peanut meal, granulated peanuts and dry roasted peanuts -- have reached consumers," it said in a statement.
FBI officials in Atlanta said on Monday they had joined the U.S. Food and Drug Administration in a criminal probe of the company.
The outbreak is the latest in a series involving tainted lettuce, peppers and spinach that have eroded public confidence in food safety and renewed calls for change at the FDA by the Government Accountability Office, consumer groups, the food industry, Congress and the Obama administration.
The House Government Reform and Oversight Committee had a hearing scheduled for Wednesday on the issue.
A Peanut Corp spokeswoman was not available for comment. The company has said it is cooperating with the FDA's investigation.
(Additional reporting and writing by Julie Steenhuysen in Chicago; Editing by Maggie Fox and John O'Callaghan)

The fear about peanut allergies is nuts
Source of Article:
Parents and medical groups are doing more harm than good stirring up worries about food allergies.By Rahul K. Parikh, M.D.
Feb. 5, 2009 | In 2005, a 15-year old Canadian teenager named Christina Desforges kissed her boyfriend and died. Her death, reported around the world, was initially blamed on peanuts. Desforges was allergic to peanuts and her boyfriend had eaten peanut-butter toast hours before their deadly smooch.
Sudden death due to an allergic reaction to food is known as anaphylaxis. When you eat peanuts (or some offending food), you break out in hives, your face swells and your larynx constricts until you can no longer breathe, all in a matter of minutes. Shocking. Tragic. Scary.
Desforges' story is the kind that has moved anxious parents, politicians and school board members to join a crusade against peanuts. Several states have passed laws mandating public schools be "peanut-free zones," and parents now hover over food labels with Draconian vigilance, checking and double-checking them for signs of peanuts. Could that knife that just cut the birthday cake have been in the vicinity of peanut butter?
Peanut-allergy panic has spread across the nation. In a recent essay, Harvard physician and sociologist Nicholas Christakis relates an incident in which a peanut was spotted on the floor of a school bus, "whereupon the bus was evacuated and cleaned (I am tempted to say decontaminated), even though it was full of 10 year olds who, unlike 2 year olds, could actually be told not to eat off the floor."
Actions like that are no doubt overdue in the minds of organizations like the 30,000-member Food Allergy and Anaphylaxis Network (FAAN), a Virginia-based advocacy organization that has led the fight to raise awareness about peanut and other food allergies in both children and adults. Go to its Web site and you'll see some eyebrow-raising points.
- The incidence of food allergies has doubled over the past 10 years.
- Food allergy is believed to be the leading cause of anaphylaxis outside hospitals, causing an estimated 50,000 emergency department visits each year in the U.S.
- Each year in the U.S., it is estimated that anaphylaxis caused by food results in 150 deaths.

Those FAAN numbers get cited in nearly every news report about food allergies. The organization's founder, Anne Munoz-Furlong, mother of a food-allergic child, is well known in the media as a food allergy expert. She has done her own research and her studies have been published in medical literature. Now major medical groups, like the American Academy of Pediatrics, have recommended that children avoid eating peanuts until age 3. As for consuming other potentially allergic foods (such as strawberries or dairy), the AAP has, until recently, suggested that kids wait until age 2.
But on closer examination, food allergies are not the epidemic we've been led to believe. FAAN's advocacy may have helped to create rules and laws that are based less on sound science than on a significant misrepresentation of facts. Ironically, by accepting these facts, we may be increasing our risk of developing food allergies.

Consider the claim that food allergies have doubled. FAAN states it drew this conclusion in part from doctors' "reports" (that is, anecdotes and not hard data about confirmed allergies). FAAN's claim is also based on a study looking at the prevalence of peanut and tree nut allergies. In that study, funded in part by FAAN, researchers, one of whom was Munoz-Furlong, obtained data by conducting a telephone survey, in which they asked questions about whether someone at home has a nut allergy.
Besides the problem that FAAN took information about a specific type of food allergy and applied it to all food allergies, telephone surveys are notoriously inaccurate. They're subject to recall bias: People have to pull events out of imperfect memories.
There's also good evidence that parents overestimate the prevalence of food allergies in their kids. In one 2005 study, parents reported that 7 percent of kids under age 3, 10 percent who were age 3, and 8 percent over 3 had food allergies. But when researchers tested those kids to confirm these self-reported diagnoses, there were no confirmed cases under 3, only 2 percent at age 3, and 1 percent over age 3. Other studies have shown similarly large discrepancies between what parents believe about food allergies and what tests confirm.

Further, what constitutes a peanut allergy for a parent is not what constitutes it for a doctor. If a child has diarrhea or vomits after eating nuts, it may signal a food allergy, but it may also mean food poisoning. The FAAN study did not confirm its subjects' claims that they were allergic to nuts. That would have required medical records and testing, neither of which were included in the study. Valid confirmation depends on a blood or skin test. Potential allergens are placed on or just underneath the skin to see if they trigger a localized allergic response. Although even those tests can be unreliable, as they don't always pinpoint which food may or may not be the problem.
Let's look at FAAN's claims that 50,000 people a year end up in emergency rooms with allergic reactions and that between 150 to 200 people die each year from anaphylactic shock. That 50,000 is extrapolated from a study in which researchers looked at emergency room visits, due to anaphylaxis, in a single hospital over 10 years. The number of visits during one year was actually 211. The researchers then estimated that 211 people from one E.R. adds up to 50,000 people across the country. Whether that's true remains to be seen. There's no evidence that visits in one hospital correspond to visits in hospitals across the country.

What's also misleading is how FAAN couches this information in its press kit: "Food allergy is believed to be the leading cause of anaphylaxis outside the hospital setting, causing an estimated 50,000 emergency department visits each year in the U.S." In fact, the study is citing any cause of anaphylaxis. FAAN suggests that 50,000 people visit an E.R. due solely to anaphylaxis from food allergies. That's simply not true.
The claim that 150 to 200 people die each year from anaphylaxis is grossly exaggerated. In 2004, the Centers for Disease Control cited just 14 deaths due to anaphylaxis. The only known registry of deaths from anaphylaxis noted 33 deaths between 1994 and 1999. Remember, all of these estimates refer to the total number of people who had an anaphylactic reaction for any reason, not just from peanuts or other foods.
Facts ought to be stubborn. In the past, Munoz-Furlong has stated that one child dying from an allergic reaction is too many. But Harvard doctor Christakis, again, puts things into perspective. "There are no doubt thousands of parents who rid their cupboards of peanut butter but not of guns," he writes, comparing the alleged 150 children and adults who died from peanut allergies to the 1,300 who die from gun accidents each year. He goes on to note that 2,000 kids drown each year. Indeed, the most common cause of death in kids is accidents. "More children assuredly die walking or being driven to school each year than die from nut allergies," Christakis writes.
The worst fallout is that doctors and medical groups who have fallen for the FAAN hype are doing more harm than good with their prescriptions to avoid peanuts. A study published last year compared the prevalence of peanut allergies in Jewish children in the United Kingdom (where young kids are told to avoid peanuts) with those in Israel (where peanuts are fine).
Unlike the survey-based studies before it, researchers administered two strictly validated questionnaires to identify kids with allergies. Then those kids were tested. In all, about 5,000 kids were included in each group. The result: Less than 2 percent of U.K. children were allergic to peanuts, compared to a mere 0.17 percent of Israeli children. The authors concluded: "Paradoxically [avoidance of peanuts] might be promoting the development of peanut allergies and could explain the continued increase in the prevalence of peanut allergies."

For those who argue that heightened awareness about food allergies is more beneficial than underestimating them, consider the psyche of kids who fear they have an allergy. They often wear a bracelet or necklace identifying them as food allergic and carry injectable epinephrine wherever they go. While those measures are justified for truly allergic kids, what about those who may not be? Research has shown these children report feeling more anxious, restrict their activity and are more worried about being away from home than even children with Type 1 diabetes.

The mismatch between the fears and the facts is beginning to surface. Recently the American Academy of Pediatrics reconsidered its policy of preaching avoidance. In a statement, it declared: "It is evident that inadequate study design and/or a paucity of data currently limit the ability to draw firm conclusions about certain aspects of [allergy] prevention through dietary interventions." In addition, a new international and comprehensive study is now under way to uncover solid data about the true incidence and prevalence of food allergies.

And what about Christina Desforges, the young girl who received the kiss from the peanut-contaminated lips of her boyfriend? She suffered from asthma and died of a severe asthma attack, likely triggered by smoke. A coroner reported that on the night she collapsed she had smoked marijuana and spent hours at a party where people were smoking pot and tobacco

Denver E. Coli Outbreak Linked to National Western Stock Show
Date Published: Monday, February 16th, 2009
Source of Article:
The number of cases in a Denver E. coli outbreak linked to a National Western Stock Show in January has risen to 27, according to Denver Public Health. Seven additional cases were found just last week, Dee Martinez, the director of marketing and public relations at Denver Health, told the Denver Post
Test results isolating the outbreak¡¯s source have not been released; however, Dr. Chris Urbina, director of Denver Public Health and the investigator¡¯s lead, said that the so-called ¡°working hypothesis¡± is that the E. coli infection is likely linked to the Stock Show given that 16 children who later fell ill attended the event, reported the Denver Post. Dr. Urbina reported test results were expected this week; Martinez said the investigation is ongoing.
E. coli are a group of bacteria found in animal intestines and feces. While some strains are necessary for digestion; some are harmful, deadly, and toxin-producing and part of a group of E. coli called Verocytotoxigenic E. coli, or VTECs, also known as Shiga-producing E. coli. Of particular concern is the virulent, sometimes deadly E. coli O157:H7 strain that is part of this group and is generally found to be the culprit in E. coli-related illness outbreaks.
E. coli may cause fatal blood poisoning, cystitis, deadly septicemia, and death. Symptoms of E. coli infection include stomach cramps and watery diarrhea that may turn bloody within one to three days. E. coli generally taints meat through improper butchering and processing practices and, once released in the body, produces the Shiga-producing toxins that have been linked to kidney damage in young children, and can also lead to kidney failure and death. The Centers for Disease Control and Prevention (CDC) report that the principal cause of acute renal failure among children in the United States is E. coli O157:H7 infections; among patients with HUS (Hemolytic-uremic syndrome), about five percent will die. Also, most cases of diarrhea-associated HUS are caused by shiga-producting E. coli (STEC), of which strain O157:H7 is most closely linked with HUS worldwide; at least 80 percent of childhood HUS is attributable to infection with STEC, primarily E. coli O157:H7.

E. coli is routinely found on cattle farms and in the intestines of healthy livestock with outbreaks occuring when meat becomes tainted during slaughter and organisms contaminate the grounding process. Tainted meat is released and consumed by the public. In recent years the transmission route for E. coli O157:H7 is shifting and not always caused by meat consumption with outbreaks occurring more and more with direct and indirect animal contact?zoonotic contact?such as at petting zoos, said the CDC. According to CDC estimates, there are over 70,000 cases of infection and 61 deaths occurring in the U.S. annually with most illness linked to undercooked or contaminated meat.

According to the Examiner and the Associated Press, all but one case has occurred in children; health officials expect to see more cases since a wide variety of schools and day care centers sponsored trips to the stock show, which took place from January 10 through the 25. Pat Grant, National Western president and CEO, said the stock show takes precautions to prevent the spread of E. coli, such as posting signs and maintaining hand-washing stations around petting areas.

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