Marler Blog

Ill people have reported eating at Subway restaurants located in 23 Illinois counties -- Bureau, Cass, Champaign, Christian, Coles, DeWitt, Fulton, Knox, LaSalle, Macon, Marshall, Mclean, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Winnebago and Will.  Age range of confirmed cases: 2 to 79. 

(38.6 cases of Salmonella infection for each culture-confirmed case see, http://www.cdc.gov/enterics/publications/374-voetscha1.pdf)

Not quite sure why I thought about Jim Croce, "Don't Mess Around With Jim," when I saw the Minnesota Department of Health press release, “Three more E. coli cases linked to raw milk from farm 
Additional testing of environmental, animal samples finds outbreak strain,” but I did.

State health officials have identified three additional cases of E. coli O157:H7 illness in Minnesotans linked to consumption of raw milk or other dairy products from a dairy farm in Gibbon, Minnesota.

Since May 26, including the new cases, a total of eight E. coli O157:H7 cases in seven different homes have been linked to products from the Hartmann Dairy Farm.

Two of the newly identified cases occurred in school-aged children who consumed milk from the Hartmann Dairy Farm. Both cases had E. coli O157:H7 with the same DNA fingerprint as five earlier cases associated with dairy products from the Hartmann farm. The other newly reported case occurred in an infant living in the same household as one of the earlier five cases. The infant had a confirmed case of E. coli O157:H7, but no stool sample was available for genetic fingerprinting in the MDH lab.

Health officials said today that 28 environmental and animal samples obtained by the Minnesota Department of Health from the Hartmann farm have now tested positive for E. coli O157:H7. Twenty-six samples had the same DNA fingerprint as the outbreak strain of E. coli O157:H7. These additional positive samples include environmental samples from the dairy barn where the cows are milked. The DNA fingerprint is unique among the more than 3,000 isolates of E. coli O157:H7 tested at the Minnesota Department of Health since 1993. This strain of E. coli O157:H7 has not previously been found in Minnesota.

Don't forget to visit www.realrawmilkfacts.com.

You don't tug on Superman's cape
You don't spit into the wind
You don't pull the mask off the old Lone Ranger
And you don't mess around with Team Diarrhea, da do da do...

For more information generally about Salmonella, visit www.about-salmonella.com.  To hear the mellow tones of me talking Salmonella, click below:

That would mean actual illnesses are now 2741 (as I was told this morning that "the right number is 38.6 cases of Salmonella infection for each culture-confirmed case, and not 38.5, see, http://www.cdc.gov/enterics/publications/374-voetscha1.pdf").  According to Andy Nelson of The Packer:

The number of cases of salmonella in Illinois with a possible link to the Subway sandwich chain has risen to 71, seven of the people stricken are still in the hospital and a state official said fresh produce was probably the culprit.

After illnesses began being reported, Subway replaced supplies of four fresh vegetables from its restaurants in the state.

Twenty-six people have been hospitalized, and seven were still in the hospital as of June 10, said Melaney Arnold, communications manager for the Illinois Department of Public Health.

As of June 10, the latest date reported for hospitalization was May 30, Arnold said. The ages of those hospitalized ranged from 2 to 88.

While originally it was not known what caused the outbreak, on June 10 Arnold said the department believed it was a fresh produce item.

The department, which is working with the Food and Drug Administration, the U.S. Centers for Disease Control and Prevention, Subway and local health departments, was investigating possible distributors of the produce but had not reached any conclusions, Arnold said.

Subway restaurants in 22 Illinois counties removed lettuce, green peppers, red onions and tomatoes from restaurants during the period in which people who got sick reported eating at a Subway — May 11 to May 25, according to the department — and replaced them with new product, according to a Subway news release.

The raw milk drinkers and I have not been getting on well lately. Since this is my blog, I do not have to write down all their descriptions of me. However, a few moments on www.thecompletepatient.com will give you a sense of their animus.

I must admit that I am not blameless. I recently described them to New York Magazine as “a combination of tea baggers and granolas.” I then got quoted in USA Today as pointing out that "[r]aw milk is where the right and left come back together. It's an intersection for the 'back to nature' and the 'don't tread on me,' people — they're the granola tea-partiers."

But, it was Michael Feldman’s Op-ed in the New York Times, “Crying Over Raw Milk,” however, that was the best, when he coined the phrase “teat party” to describe the political phenomena.

So, is the “teat party" a "farce to be reckoned with" or “udderly ridiculous?”  My suggestion is to spend time on www.realrawmilkfacts.com and decide for yourself.

No, really - keep reading. 

According to the Illinois Department of Health, the outbreak of Salmonella sicknesses in Illinois linked to Subway restaurants is spreading. To date, there are 68 confirmed cases, of which 24 had been hospitalized. People with the illness reported eating at Subway locations in central Illinois 24 counties.

According to the CDC, for every one person who is a stool-culture confirmed positive victim of salmonella in the United States, there a multiple of 38.5 who are also sick, but remain uncounted. (See, AC Voetsch, “FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States,”Clinical Infectious Diseases 2004;38 (Suppl 3):S127-34). This means that in this Subway Salmonella Hvittingfoss outbreak of 68 (this number is bound to rise), we are missing 2,550 people so far.

A few critical questions to ask Subway:

1.  Didn't you just have a Shigella outbreak?

2.  Given that this Salmonella outbreak is in 24 counties, and you recalled various vegetables (lettuce), will you also name your suppliers and tell us if you had any requirement for product testing?

3.  Will you commit to paying for the medical expenses and lost wages of your sickened customers?

Yesterday after giving a speech to NEHA on the dangers of the industrialized beef supply, I received the following email statement from the Hartmann Dairy which is at the center of an E. coli O157:H7 outbreak in Minnesota that has sickened at least five. Here is the relevant part of the email:

Not a single test of raw milk was found to contain any strain of e.coli.

At paragraph 9, the State wrote in the Petition that of the 103 samples tested, 9 samples tested positive for e.coli, a bacteria found in the lower intestines of virtually all mammals. Of the 9 samples, none was from any milk cow; 4 calves manure (not milked), manure from a cow pen (beef cows, not dairy, not milked), manure from a pasture for dry cows (not milked), manure from a steer yard (steers are not milked), manure from 2 heifers (not milked), and manure from one sheep (not milked). No claim is made that any sample from a dairy cow or the dairy barn contained any e.coli.

Two samples of cheese, one cheddar and one herb and spice Gouda, made from raw milk were found to contain a strain of e.coli that the state could not identify as e.coli 0157:H7. A third positive test for an unidentified strain of e.coli was taken from a bucket of clean-up rinse water. As everyone knows, cheese is intentionally cultured with bacteria to create the product and until a specific strain is identified there is no evidence of contamination.

As of today, there is no evidence of any harmful bacteria in any raw milk, cheese, meat or other product sampled from the Hartmann farm. The State has engaged in a serious regulatory and potentially criminal action in a grossly negligent manner with total disregard for the defamatory content of their media campaign.

Minnesota Department of Health responded. The response, in part, is below:

What evidence do you have that raw milk from the Hartmann farm caused the illnesses?

This investigation began like many other foodborne investigations: Someone becomes ill, sees their physician and the physician sends a stool specimen to a clinical laboratory. If that laboratory finds, or “isolates”, one of a number of illness-causing bacteria (eg., Salmonella, E. coli O157:H7), they send that bacterial isolate to the MDH Public Health Laboratory (PHL) for further testing. Each bacterial isolate is DNA fingerprinted by a technique called pulsed-field gel electrophoresis (PFGE).

During May 2010, E. coli O157:H7 isolates from 5 patients sent by separate clinical laboratories to the MDH PHL were found to all have the same DNA fingerprint by PFGE testing.

This particular DNA fingerprint type (which also can be called a “strain”) of E. coli O157:H7 had never been seen before in Minnesota. The fact that multiple patients all were infected with this new strain in such a tight timeframe indicates that there was a common source for the illnesses. In other words, the patients must have acquired their infection from the same source.

In any foodborne illness investigation, MDH epidemiologists interview patients about an extensive array of possible exposures. These interviewers use a standard questionnaire and interview technique. This includes asking questions about what the ill people ate, including meat, produce and other food items. It also includes questions about recreational water and drinking water, contact with animals, daycare attendance, and more.

In this outbreak, the ill people came from communities across Minnesota, and the only exposure the cases had in common was consumption of raw dairy products from the Hartmann farm. This connection, and the fact that the same strain of E. coli O157:H7 found in the ill people was found in several animals and from several environmental samples on the Hartmann farm, clearly indicates that the farm was the source of the E. coli O157:H7 that made the people ill.

What is the significance of finding E. coli O157 in the environmental samples from the farm?

The strain found on the farm matches the strain found in the cases of illness. Again, this is a strain that has never been seen before in Minnesota.

This tells us that the bacteria that sickened the people was on the Hartmann farm and since several of the people that became ill never visited the farm, their only potential source would have been food products from the farm.

Did you find the outbreak strain in dairy product from the cases’ homes or from the farm?

The outbreak strain of E. coli O157:H7 has not been found in product yet. However, product samples that were collected from the farm were obtained one week to several weeks after production of products that made people sick. Other strains of Shiga toxin-producing E. coli were found, indicating an ongoing problem with contamination.

The fact that the outbreak strain was not found in samples of product taken from the farm or homes does not mean it wasn’t in the product that sickened the individuals. In many cases, only particular batches of product may have been contaminated. The product from the contaminated batches may not be available for testing because it has already been consumed. Even if the contaminated batches are available for testing, the contamination may not be uniformly distributed throughout the product. It can be difficult to find the “needle in the haystack” when only small amounts of product are able to be used for a laboratory test. The fact that some pathogen was not found in a sample taken today does not mean it wasn’t there yesterday or a week ago, or won’t be there tomorrow. Also, since raw milk contains many types of bacteria it is a difficult process to isolate individual bacteria growths and find the disease-causing strains.

The outbreak strain of E. coli O157:H7 was found in the manure of some individual calves, sheep, and cattle pens. Of note, the calves were likely drinking the same milk as that consumed by the cases.

Standard public health practice does not require finding the illness strain of pathogen in either environmental or product samples in order to determine the source of an outbreak and before intervention to prevent further illness should be initiated. In fact, it is quite rare in foodborne investigations that food product is available for testing as it is often perishable or has been completely consumed by the time the outbreak is recognized. State health and agriculture officials often act on epidemiologic evidence to remove contaminated products from the marketplace and prevent additional illnesses. Indeed, to do nothing in the face of such compelling evidence would be irresponsible – regardless of the size or nature of operation implicated.

Are there more cases being investigated?

Yes, MDH has received additional reports of illness in several consumers of Hartmann dairy products that it is investigating.

The Minnesota Department of Health Epidemiologists and the Health Department lab are considered the best in the country at investigating foodborne outbreaks.  Its response to the Hartmann Dairy is as devastating to Hartmann's wishes as it is accurate and clear.

Since I filed the Petition last October, Mr. Derfler and I have kept up a lively pen pal relationship.  Here is his latest:

I continue to hope that one day I will get a letter from Mr. Derfler saying that FSIS simply now finds that in fact non-O157's are in fact adulterants.

The Illinois Department of Public Health (IDPH) today reported 60 cases of Salmonella ser. Hvittingfoss associated with the ongoing investigation of illnesses among customers who ate at certain Subway restaurants in Illinois. All cases are recovering, of which 17 had been hospitalized.

As of today, Salmonella cases identified in this outbreak reported eating at Subway locations in 22 counties -- Bureau, Cass, Champaign, Christian, Coles, DeWitt, Fulton, Knox, LaSalle, Macon, Marshall, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Winnebago and Will. At this point in the investigation, no cases have reported eating at Subway restaurants in the southernmost portion of Illinois. Illnesses are reported to have started between May 11 and May 25 and cases range in age from three-years to 88-years-old.

At this time, a specific food source has not been identified in association with this outbreak. The Illinois Department of Public health is working closely with the Food and Drug Administration, the Centers for Disease Control and Prevention, the Subway restaurant chain and local health departments throughout the state to identify the source of illness.

The specific type of Salmonella involved in this outbreak is an uncommon serotype called Hvittingfoss. Typically, only one to two cases of this type of Salmonella are seen in Illinois per year.

I just finished up my speech at NEHA.  Although the speech was well received, the real hit at the conference were the "teat" shirts and buttons with the following logo:

Comment below if you want a shirt or a button.

Dr. Raymond does a blog (or at least he used to) over at www.meatingplace.com. I am stealing one he did today below:

I think almost every reader of this blog knows OF Bill Marler, but I wonder how many readers really KNOW Bill Marler?

For sure, he is the most prominent and recognizable plaintiffs’ attorney in foodborne illness litigation (and also non-foodborne illnesses such as petting zoos, drinking water, etc.) but he is also one of the most prominent and recognizable food safety advocates. So I think I am very safe in saying he is not loved by many of the readers, and it is also safe to say that many of the readers today are glad Bill Marler is advocating daily for a safer food supply thru his blogs, his online journals, and his support for consumer education and legislation.

Yes, Bill Marler started his ascent to becoming a common name in the food industry circles when he won a judgment of $15.6 million for Brianne Kiner in the 1993 Jack in the Box outbreak. But many don’t know that when he recently won a case for the parents of Abby, a child who died of an E. coli infection in 2009, he donated funds to establish a scholarship in her memory at the school she had attended.

Yes, Bill Marler sued Cargill on behalf of Stephanie Smith for $100 million (it has been settled for an undisclosed amount) but in the same year, he received the Food Safety Leadership Award for Innovation in Education from NSF International. He was also seen handing out meat thermometers at the FSIS Consumer Education Conference in Atlanta, and was seen at the annual International Food Safety Conference in Beijing, China, the last three years as a prime sponsor.

Yes, Bill Marler has won over $500 million in litigation for his clients over the years (and earned his commission, of course) but he has also established a daily food safety blog site, www.marlerblog.com, that he contributes to several times a day and a daily electronic magazine with at least four full time writers and many free lancers called Food Safety News, www.foodsafetynews.com, that helps keep readers up to date on all food safety issues of the day. Both of these methods of communicating food safety news also have valuable links to other blogs and stories. In addition, Marler has recently gone on line with his Foodborne Illness Database,www.outbreakdatabase.com, with links available there to CSPI’s and CDC’s outbreak databases.

To be sure, Bill has some that do not appreciate his advocating for victims of foodborne illnesses, but he has others that wish he had achieved his dream of being the current Undersecretary for Food Safety at the USDA. He may be accused of “courting publicity”, but without publicity, his, and his clients' voices, would not be heard. He has written extensively, testified before Congress, presented at many conferences, and was even a factor in convincing the Wisconsin and California Governors to veto bills that would have liberalized the production and sale of raw milk.

While spending nearly a half million dollars of his own money (yes, money earned by representing victims of foodborne illnesses) to test 5,000 samples of ground beef for non-O157:H7 Shiga Toxin producing E. coli, he petitioned the Food Safety Inspection Service at the USDA to recognize and regulate all enterohemorrhagic E coli as adulterants in ground beef. And by the way, this testing found that nearly 2% of samples were contaminated with non-O157 E coli, and that means fecal presence. One sample tested positive for O157:H7 and resulted in a non-FSIS initiated recall.

I call that aggressively protecting the public from a foodborne illness, but am interested in hearing what you call it.

The CDC announced that a total of 35 individuals infected with a matching strain of Salmonella Newport have been reported from 11 states since March 1, 2010. The number of ill people identified in each state with this strain is as follows: AZ (2), CA (17), CO (1), ID (5), IL (1), MO (1), NM (1), NV (2), OR (2), PA (1), and WI (2). Case-patients range in age from <1 to 75 years old, and the median age is 36 years. Sixty-six percent of patients are female. Among the 30 patients with available hospitalization information, 7 (23%) were hospitalized. No deaths have been reported.

J.H. Caldwell and Sons Inc. of Maywood, CA, recalled several brands of alfalfa sprouts distributed to wholesale distributors, restaurants, delicatessens, and grocery stores.

Not including this outbreak, since 1990, raw or slightly cooked sprouts have caused an estimated 2,273 illnesses, through 37 outbreaks. The U.S. Food and Drug Administration (FDA) estimates that sprout-link outbreaks account for 40 per cent of all food-borne illness associated with produce. This has prompted the FDA to issue this warning:

Health Risks with Raw Sprouts

Raw sprouts that are served on salads, wraps, and sandwiches may contain bacteria that can cause foodborne illness. Rinsing sprouts first will not remove bacteria. Homegrown sprouts also present a health risk if they are eaten raw or lightly cooked.

• To reduce the risk of illness, do not eat raw sprouts such as bean, alfalfa, clover, or radish sprouts. All sprouts should be cooked thoroughly before eating to reduce the risk of illness.

• This advice is particularly important for children, the elderly, and persons with weakened immune systems, all of whom are at risk of developing serious illness due to foodborne disease.

Interestingly, the FDA sets forth a similar warning for raw milk consumption:

According to the Centers for Disease Control and Prevention, Raw milk can cause serious infections. Raw milk and raw milk products (such as cheeses and yogurts made with raw milk) can be contaminated with bacteria that can cause serious illness, hospitalization, or death. These harmful bacteria include Brucella, Campylobacter, Listeria, Mycobacterium bovis, Salmonella, Shiga toxin-producing E. coli, Shigella, Streptococcus pyogenes, and Yersinia enterocolitica. From 1993 to 2006, 69 outbreaks of human infections resulting from consumption of raw milk were reported to CDC. These outbreaks included a total of 1,505 reported illnesses, 185 hospitalizations and 2 deaths.These harmful bacteria can seriously affect the health of anyone who drinks raw milk, or eats foods made from raw milk. However, the bacteria in raw milk can be especially dangerous to pregnant women, children, the elderly, and people with weakened immune systems.

Yet, is there a ban on the interstate sale of raw milk? Are there bans and restrictions on the sale of sprouts? Again, interesting issue.

WIFR reports that the Illinois State Health Department is investigating what led to a salmonella outbreak linked to some Central Illinois Subway shops. Two of the 34 cases have been reported in Ogle County. Candy Johnstone said she is one of the victims of the salmonella outbreak linked to subway shops throughout central Illinois. She said she ate a veggie sub at the location on 7th street in Rochelle about three weeks ago. It was the same time these illnesses started being reported. State Health Investigators said the 7th street location in Rochelle is being investigated because of two cases reported in Ogle County.

The attorney for this shop issued a statement. In part, it said that Subway has taken precautionary measures by destroying lettuce, green peppers, red onions, and tomatoes that are suspected ingredients for the outbreak. Subway corporate managers said all Subway locations have done this. They too, issued a statement today explaining they have high standards for produce vendors, and that all produce is checked by Subway and by third party auditors.

Really? Does Subway test all its lettuce for pathogens, like Salmonella?

At least 15 people became ill with Salmonella infections last month after attending the Margarita Mix-Off in Chico, California. Three of the fifteen were hospitalized due to the severity of their illnesses.

The Margarita Mix-Off was hosted at Manzanita Place in Chico on May 8, with a local caterer providing food served at the event. Butte County public health officials have thus far been unable to determine the source of the outbreak despite conducting extensive interviews with people who got sick.

AP reported today that the state of Washington revoked the license of a Southwest Washington in-home day care where Four-year-old Ronan Wilson contracted a fatal case of E. coli.  Dianne and Larry Fletch had operated the Hazel Dell day care for more than 20 years. Their license had been suspended in April while the state investigated.

The couple told The Columbian newspaper they will appeal.

Four-year-old Ronan Wilson of Hazel Dell died April 8 after a week at a Portland hospital.  Other children and adults who had been in the home also were sickened by E. coli bacteria.

l will be heading to New Mexico on Monday to the NEHA Conference after a short stop in Las Vegas to attend the high school graduation of the twins son's of Linda Rivera.  Linda is still in Rehab after being hit by E. coli O157:H7 in April of 2009.  Here is the outline of my speech:

The couple of blank slides are videos of the Larry King Show on E. coli and a short story of Abby Fenstermaker - in life and death.  I will add them in before the presentation next week.

l will be heading to New Mexico on Monday to the NEHA Conference after a short stop in Las Vegas to attend the high school graduation of the twins son's of Linda Rivera.  Linda is still in Rehab after being hit by E. coli O157:H7 in April of 2009.  Here is the outline of my speech:

The couple of blank slides are videos of the Larry King Show on E. coli and a short story of Abby Fenstermaker - in life and death.  I will add them in before the presentation next week.

Strike One - Subway Hepatitis A Outbreak - Washington

Strike Two - Subway Restaurant Shigella Outbreak - Chicago

Strike Three - The Illinois Department of Public Health and local health departments throughout the state are investigating the cause of Salmonella illnesses among customers who ate at certain Subway restaurants in Illinois. To date, 34 cases of Salmonella have been confirmed with this outbreak and all are recovering, of which 14 had been hospitalized.  The specific type of Salmonella involved in this outbreak is a rare serotype called Hvittingfoss.

Salmonella cases identified in this outbreak reported eating at Subway locations in 14 counties, including Sangamon, Schuyler, Christian, Bureau, LaSalle, Cass, Champaign, Peoria, Shelby, Warren, Macon, Ogle, Fulton and Tazewell. At this point in the investigation, no cases have reported eating at Subway restaurants in either northeastern or southernmost portions of Illinois. Illnesses are reported to have started between May 14 and May 25 and cases range in age from six-years to 88-years-old.

You're Out!

The State of Minnesota just published this press release on the ongoing E. coli O157:H7 outbreak:

Laboratory testing conducted by the Minnesota Department of Agriculture (MDA) and the Minnesota Department of Health (MDH) this week provided additional evidence that the Hartmann dairy farm, of rural Gibbon, was the source of a strain of E. coli O157:H7 bacteria that sickened at least five Minnesotans after they consumed raw, unpasteurized milk or other dairy products from the farm. MDH reported four cases of illness last week, and a fifth case has subsequently been confirmed in a young child who was not hospitalized.

MDH first discovered the outbreak through reports of E. coli O157:H7 illness from health care providers. The department conducted an investigation into the illnesses, which were scattered across the state, and found that the only thing the ill people had in common was consumption of dairy products from the Hartmann farm. This strong epidemiological link is now reinforced by the laboratory confirmation that the specific strain of E. coli O157:H7 found in the ill patients has also been found in multiple animals and at multiple sites on the Hartmann farm. This strain of E. coli has not previously been found in Minnesota. Furthermore, laboratory tests confirmed that cheese samples collected last week from the farm contained another form of Shiga toxin-producing E. coli, demonstrating that an ongoing pathway of contamination existed on the farm.

... In addition to the cases linked to the Hartmann farm, MDH is investigating several other illnesses with a connection to products from the farm. MDA has embargoed dairy products on the Hartmann farm, prohibiting movement or release of the products off the farm.

It is illegal to sell raw milk in Minnesota, although occasional sales are allowed on the farm where the milk is produced. ...

My emphasis above.  Hammer, hammer.

For more information about raw milk, visit www.realrawmilkfacts.com.

I must admit that I tire of the moans from raw milk advocates that Big Dairy and Big Government is out to get them. I shake my head at the unfounded belief that grass fed cows will never produce a pathogen that can sicken a child. I cringe at the anti-science blather protesting that all outbreaks linked to raw milk never happened, or were caused by something else, or were part of some dark conspiracy designed to discredit what is really a wonder-product. I wish that I had a nickel for each time a raw milk aficionado claimed that I am a tool of the FDA, or State and Local Health Departments, who apparently wrongly nailed a poor raw milk farmer who poisoned a few customers.

Despite the whining to the contrary, raw milk outbreaks do happen and will happen. As I said late last week, Health department officials in Minnesota reported three, and possibly four, E. coli O157:H7 infections linked to drinking raw milk from a dairy in Gibbon, Minnesota. All of the sick were infected with a strain of bacteria that had the same-pulsed field gel electrophoresis (PFGE) pattern, or DNA fingerprint. One infected child developed Hemolytic Uremic Syndrome (HUS), and is still hospitalized.

Despite the protests from the “raw milkies,” there have now been at least nine outbreaks scientifically linked to raw milk since January 2010. The other states with outbreaks include Nevada, Utah (two outbreaks), New York, Pennsylvania, Washington (two outbreaks), and a multistate outbreak in Michigan, Indiana, and Illinois. Dozens of people have been sickened in these outbreaks; some very seriously so.

But, is raw milk treated unfairly? Have health departments brought the hammer down on raw milk, while giving a free-pass to other dangerous products? As someone once said, “just because they are paranoid, does not mean they are not out to get them.”

This may be a bit of a shocker to my raw milk fans, but, on this, I may agree with them—which clearly must mean that I’ve gone off the reservation, or stopped being a so-called lap dog (or attack dog) of the FDA and Big Ag. Let me be clear though: I am not saying that health officials should not crack down on raw milk producers who poison customers. Nor am I saying that raw milk producers should escape being held accountable for the injury and damage caused by contaminated raw milk. I simply believe that raw milk producers should be treated no more—or less—strictly than any other producer of unsafe or contaminated food products. And this is especially true for ready-to-consume products, like raw milk or fresh produce, where there is no kill-step involved in the production process. Bottom line: Raw milk outbreaks should be publicized, but so must outbreaks involving contaminated lettuce.

But the problem here is that I do believe there’s a double standard. Why is raw milk emphatically criticized when it causes illness while some lettuce producers are allowed by public health officials to escape public scrutiny when their contaminated product has caused illness? And just so you don’t think I’m exaggerating, here are some problematic lettuce outbreaks that were essentially kept secret—that is, until I discovered the fact of such outbreaks and went public with the news:

Romaine lettuce, May 2008: In May 2008, Washington State Department of Health learned of a small cluster of E. coli O157:H7 illnesses amongst Pierce and Thurston County residents. Over the several days that followed, a total of 5 E. coli O157:H7 illnesses were reported in those counties. Testing by WSDOH showed that the bacterial isolates from four of these positive stool samples were indistinguishable after PFGE testing. By the end of the week of May 26, 2008, nine laboratory-confirmed cases and one epidemiologically linked case had been reported. WSDOH testing determined that all nine lab-confirmed cases had indistinguishable PFGE patterns.

Interviews revealed three clusters of illness: three cases at Pacific Lutheran University; three cases from a banquet at La Quinta Inn in Tacoma; and three illnesses amongst students in the Olympia School District. Further, investigators learned from the food histories of all cases that the only food consumed by all cases was lettuce.

Traceback investigation ultimately showed that the implicated romaine lettuce had been distributed to these locations by Northwest Fruit and Produce, a Tacoma-area distributor, and had been manufactured and processed by a string of companies from Salinas, California. The lettuce was grown by Andrew Smith Company at Braga Ranch, packed by Paul’s Pak, and shipped to a processing facility owned by True Leaf Farms. Church Brothers ultimately marketed the lettuce for sale on behalf of a now-defunct produce company called Premium Fresh Farms. No recall, no publicity.

Spinach, August 2008: In August 2008, five case patients with E. coli O157:H7 were reported in Multnomah County, Oregon. Testing of patient isolates by PFGE and MLVA revealed that all five patients were infected with a specific subtype. Public health investigators conducted a case-control study. Results showed that consuming raw spinach had the strongest statistical association with illness. Product traceback of spinach led Oregon investigators to spinach grown by an Organic Farm in Monroe, Washington.

A link between E. coli O157:H7 illness and spinach continued when a second outbreak of E. coli O157:H7 that was identified in Washington state. Investigators in Washington identified five laboratory confirmed cases that were a genetic match by PFGE and MLVA to the Oregon cluster. The first date of illness onset was August 28, 2008. The last case became ill on October 2, 2008. Washington case patients also reported eating organic loose spinach at a variety of locations where the spinach was sold. These included the Port Townsend Coop and deliveries of spinach sold through community supported agriculture (CSA) programs. No recall, no publicity.

Romaine lettuce, October 2008: In October 2008, 3 case patients with E. coli O157:H7 sharing an indistinguishable PFGE pattern combination were identified in San Diego and Orange County, California. All three cases had eaten salads containing romaine lettuce served at Cheesecake Factory restaurants within two days of each other. The subtype was unusual, prompting a cluster investigation coordinated by the CDC. Through OutbreakNet, a fourth case-patient in the cluster was identified, an 18 year old resident of South Dakota. This patient, a recent visitor to San Diego, had eaten a salad at one of the two Cheesecake Factory restaurants identified earlier by two patients. Furthermore, the three case-patients had all eaten at the restaurant on the same day.

County restaurant inspectors conducted an investigation into the source of the lettuce at the two Cheesecake Factory restaurants. Both restaurants received Andy Boy brand romaine lettuce from Fresh Point, a company based in Los Angeles. The outbreak quickly grew beyond Southern California. Public health laboratories continued to report PFGE matches to the outbreak strain. Case-patients were identified in Illinois, Florida, New Jersey, and Ohio. These individuals reported restaurant exposures but none ate at a Cheesecake Factory.

This led investigators to suspect a contaminated ingredient was in the marketplace. Canadian investigators in Ontario identified an outbreak involving 55 persons with at least 13 ill case patients culturing positive for the outbreak strain. The majority of cases were linked to one of two restaurants. Illnesses occurred between October 11 and October 28. Canadian investigators conducted a case-control study and lettuce was statistically associated with illness. Product traceback showed that two restaurants tied to the outbreak shared a common produce supplier and that Andy Boy brand romaine lettuce was the only lettuce in common to all Canadian restaurants with outbreak cases. No recall, no publicity.

Romaine lettuce, summer 2009: In late-July and early-August 2009, at least 100 people were infected by a matching strain of Salmonella typhimurium in Oregon, Washington, Idaho, Colorado, Montana, and possibly other states. The cluster of illnesses was first recognized in mid-August. Early in the large-scale investigation that followed, involving the CDC, FDA, and health agencies from all affected states, it was thought that other PFGE-matched typhimurium cases nationally were part of the outbreak, but later MLVA analysis distinguished some of these cases from the July/August 2009 outbreak. Epidemiological investigation by the Washington State Department of Health, in conjunction with information from MLVA-matched individuals in other states, ultimately identified shredded iceberg lettuce from multiple retail locations, some very common, as the outbreak vehicle. In Oregon and Washington, these retail locations included, among others, Subway, Cash and Carry, Taco Del Mar, Burger King, Quiznos, Big Town Hero, Bandito’s Burrito, Taco Lobo, and Jalapeno Restaurant. Washington State health officials conducted traceback analysis on multiple common ingredients served at these locations, including shredded lettuce, cheese, and tomatoes; but only lettuce was found to have uniformly come from a common supplier. No recall, no publicity.

Lettuce, Spring 2010: Finally, health officials in the Upper-Midwest investigated and confirmed a link between several Salmonella illnesses and the consumption of lettuce products from Fresh Express, a subsidiary of Chiquita Brands International Inc over a month ago. Again, no recall and no publicity.

Again, I am not saying that public health officials should ease up on raw milk; they most definitely should not. But, there is still an issue of fairness here. And despite the public health officials telling me that they cannot publicize every outbreak, I don’t buy that as either an explanation or an excuse. I also don’t buy the argument that a perishable item like lettuce is likely to have already been eaten by the time they figure out, after the fact, an outbreak has happened. Can’t the same thing be said about raw milk?

Telling the public that there was an outbreak linked to a given food product is a duty that public health officials may not shirk. Telling the public that a lettuce producer poisoned customers is just as important as reporting about a raw milk farmer’s product. Consumers need that information so they can vote with their pocketbook. Businesses that poison their customers need to have a light shone on them so both policy makers and other business can learn from the mistakes. Our free market does not function if information about the safety of our food is hidden from us.

Treating businesses equally and fairly is the right thing to do. It’s good for consumers and good for business—even ones selling raw milk.