Eating Dangerously Read online

  The federal government’s tendency to avoid naming names, safe food advocates say, robs consumers of vital information. In an October 2011 Salmonella outbreak that sickened sixty-eight, federal agencies told journalists there was no public benefit in being more specific than problems at “Restaurant Chain A.”

  It was the Oklahoma health department that disclosed the chain where many victims had eaten was Taco Bell, but not because it had planned on telling the public. Taco Bell’s identity was revealed after journalists from Food Safety News and other outlets filed a public information request with the state health department in Oklahoma, one of several states where people were getting sick after eating fast-food tacos.11 The reporters wanted documents related to the outbreak investigation. Oklahoma health officials released them without redacting the restaurant name.

  The CDC’s final report on the outbreak, which spread across ten states, still identifies the source as “Restaurant Chain A.”12

  The Oklahoma State Department of Health had not previously revealed Taco Bell’s name in any press release that warned of the outbreak. Their reason? By the time health officials figured out what was causing the illnesses, the threat had passed. The cluster of people who were ill was no longer growing. Also, food investigators were never able to pinpoint the exact ingredient that was contaminated, although 90 percent of the ill reported they ate lettuce. “If there is no ongoing threat, a decision might be made to not put out any public notification at that time,” said Lawrence Burnsed, director of the Oklahoma department’s communicable disease division.13

  Several other state health departments around the country cited confidentiality in denying the records requests.

  National epidemiologists all but ruled out ground beef, even though 94 percent of people reported their Taco Bell meal contained beef. The way “Restaurant Chain A” handles and cooks its beef gave them little reason to suspect the meat. Also, the epidemic curve of the outbreak—a sharp increase and decline in victims that lasted one or two months—gave the impression the bad food was produce, not meat.

  The FDA could not crack the case, despite trying to track back from the restaurants to delivery trucks to the suppliers. The agency analyzed the supply truck delivery routes and schedules to various Taco Bells, trying to create a timeline or connection between food deliveries and Taco Bell customers who grew sick. Investigators discovered that the onset of customers’ illnesses was linked to more than one food shipment—not helpful in trying to nail the precise food and farm.

  Even though federal investigators could not for certain say the Salmonella-tinged food was in fact lettuce, or cheese or tomatoes, and even though it seemed that whatever had made people sick was gone from the food chain, many health advocates criticized the CDC for not naming Taco Bell. Didn’t consumers have a right to know, they asked, that Taco Bell was serving food that sent people to emergency rooms with abdominal cramps and bloody diarrhea, forcing them to miss work or school for several days? Shouldn’t consumers have that knowledge to use as they see fit—whether it’s to avoid Taco Bell, or to figure it could have happened at any restaurant and carry on eating there?

  For some, it was especially troubling that the federal government was protecting Taco Bell when it wasn’t the first time in recent years the Mexican fast-food chain was linked to a national outbreak.

  Just a year prior, in the summer of 2010, 155 people in twenty-one states were sickened by Salmonella in an outbreak linked to Taco Bell restaurants, according to Oklahoma public health records.14 Following the same protocol as in 2011, the CDC’s final report again refers to the source of the contaminated food as “Restaurant Chain A” and not Taco Bell. And same as in 2011, epidemiologists were not able to pinpoint which Taco Bell ingredient was tainted.

  The FDA, in response to harsh criticism for not revealing Taco Bell’s name in 2011, issued this statement:

  FDA strives to provide reliable information and be as transparent and proactive as possible, particularly when there is an issue that threatens the public health. In situations where there are current illnesses associated with a specific food manufactured by a specific firm, or contaminated foods are distributed without known illnesses, FDA will continue to issue health advisories and press releases, as needed, to provide consumers with specific information so they may take steps to decrease their risk of illness and avoid further exposures.

  We will also continue to work with CDC and State health officials to provide support during their investigations. We are currently re-examining our practices and policies to ensure they will provide as much transparency as possible while adhering to laws and regulations.

  The CDC stuck with “Restaurant Chain A” for its final report on the outbreak, despite that Oklahoma had disclosed many of the victims had eaten at Taco Bell. In a statement, Taco Bell said the CDC had never discovered the definitive source, but they acknowledged that some of the victims had eaten at the chain.15

  Kansas State’s Powell argued for more disclosure. At the least, he said, CDC policy should make it clear why the agency names some restaurants and producers and not others. “If Taco Bell keeps making people sick with lettuce, I want to know it’s Taco Bell,” he said. “How bright are they in choosing their lettuce suppliers?”16

  Cronquist said Colorado tries to strike a balance. If the public is still at risk from food, companies are identified. But the state also needs compliance from various facilities while it investigates. Moreover, victim interviews can be skewed by early disclosure; if they have heard “Taco Bell” or “green onions,” it can bias their answers.

  Perhaps worse than not naming names is a failure by the FDA to pursue certain national outbreaks—especially those involving leafy green vegetables. Foodborne illness investigators in some states call it the federal government’s “cone of silence”; a problem because investigators at the state level have to rely on federal agencies when outbreaks cross state lines.

  One such case began in the summer of 2009. In Colorado, it was state fair time, a time of year that always causes anxiety among foodborne illness officials. The crowds, heat, open-air food booths, portable trailers serving up tacos and chili cheese fries. It’s like asking for trouble. When the state lab connected two cases in children of the sometimes deadly E. coli O157:H7 by matching their DNA strains, investigators acted quickly.

  Both kids had gone to the Colorado State Fair, investigators from two counties learned through patient questionnaires. State officials urged them to go back to the families with more questions and try to nail down where exactly the kids ate, and what foods.

  As they waited for more answers, researchers in Minnesota, Iowa, and three other states loaded illness cases into the national network that tracks DNA fingerprints of food-illness bacteria strains. Ill people in Minnesota, Iowa, and North Carolina had eaten at the same Italian-style restaurant in Omaha, Nebraska, in early September. When Colorado got its deeper case histories back, it found both state victims had eaten at an Italian-style restaurant in Pueblo. It wasn’t the state fair connection, after all.

  More questions zeroed in on house salads. Even when the victims hadn’t ordered salad, they had nibbled from a family member’s plate. Eight of ten cases had eaten lettuce at a restaurant, according to a Colorado outbreak memo obtained through the open records act. States tried to find out the restaurants’ suppliers. Colorado learned that the lettuce used in Pueblo came from a major produce supplier in the Salinas Valley of California, Tanimura and Antle, which did not respond to requests for comment.

  The patients, meanwhile, made slow recoveries. Some were in the hospital for days. E. coli is particularly worrisome to food experts because it can cause severe gastroenteritis, pneumonia, and kidney failure.

  And then the FDA and CDC dropped the case.

  “I will forever be mad that the FDA didn’t pursue” those 2009 E. coli cases, said Kirk Smith, a veterinarian and supervisor of t
he foodborne disease investigation section of the Minnesota Department of Health. “It was a smaller outbreak, but still, if you figure out what the food is, even after the fact, you can hopefully get back to where that food was produced and perhaps correct something so there’s not a bigger outbreak in the future.”17

  Public health officials in Colorado and Minnesota privately vented frustration and derision at the FDA for going easy on food producers through “hypocritical” silence, and for failing to pluck the “low-hanging fruit” of pathogen knowledge available in an outbreak probe. Instead of tracing the cases back to the farm and figuring out how a potentially deadly bacteria was making its way onto lettuce, the cases stayed in food safety’s bureaucratic background.

  The FDA’s decision to let the six-state E. coli probe go dormant, despite clear leads, blocked efforts to force better growing and packing methods. “As someone who is out in fields with farmers, it’s really hard to get them excited about food safety if they never hear about other outbreaks,” said Doug Powell, a Kansas State University food scientist who advocates for wider probes and public disclosure. “We have evidence that telling stories makes a difference.”

  State-level investigators realized the federal government was dropping the case when they asked for a status update on the probe. According to email records released to the Denver Post under open records laws, CDC epidemiologist Colin Schwensohn told the states “with no recent cases, this cluster is less of a priority.” The threat had passed, so the federal agencies would not pursue the cause.

  Minnesota’s Smith fired back: “I think it is a huge mistake for FDA to drop this.” Smith’s email to the CDC and other investigators, which he acknowledged was a “rant,” went on: “If FDA won’t fully engage and work backwards from two restaurants on a rock solid lead, then all of their claims about making things better are all so much talk.”

  Colorado officials were also irritated. “Colorado and other states challenged this decision, but FDA did not change its position about pursuing the traceback further,” according to a state memo. Colorado epidemiologist Alicia Cronquist said in an interview, “We were extremely frustrated.” State investigators voiced their complaints in a conference call with federal officials, arguing a deeper probe could help prevent future outbreaks.

  The FDA declined comment, beyond the limited information about the federal agencies’ reasoning contained in emails at the time. Neither the FDA nor the CDC offered responses to specific questions about the 2009 outbreak, or to general questions about how investigations end.

  The case may have been weakened by lack of a key lab link. Investigators prefer to have positive tests for pathogens on the food itself, matching results from patients. In the 2009 outbreak, the suspect food was long gone. Colorado officials acknowledged the failure to follow through on the investigation was related to money. “We all operate under pretty severe financial restraints, and we need to pick and choose which clusters we investigate, and which tracebacks are performed,” Cronquist said.

  The unsatisfying conclusion to the 2009 E. coli cases bothered some food experts, beyond the failure to put “boots on the farm” and search for pathogens. They also wanted state and federal officials to name names more often and to put pressure on businesses by exposing those who fail.

  “Consumers of food have a right to know, period. And as taxpayers, consumers have a right to know what public health officials know about those same food producers,” said Seattle attorney Bill Marler, one of the nation’s top foodborne illness litigators.

  Early emails in the 2009 outbreak identified the restaurants that consumers said they had in common. Colorado named the produce grower, Tanimura and Antle, in its wrap-up memo, but said the restaurants did not appear to be at fault. Tanimura and Antle did not return calls seeking comment.

  Despite their other frustrations, some public health officials say the FDA is making progress in outbreak investigations overall. They say the agency has streamlined its outbreak teams and can move quickly, as evidenced by rapid conclusions in the Colorado cantaloupe probe. Minnesota’s Smith said his 2009 “rant” was “the nadir of working with the FDA. Since then, in part we hope because of our harping, they know they need to do more. Things aren’t perfect, but they are still progressing.”

  4

  The Whole World in Your Kitchen

  It’s late on a Saturday afternoon in the backyard, the smoke from the grill is drifting off in a breeze, blowing across a picnic table piled with fresh summer fruit, overflowing salad bowls, and platters layered with spicy cheeses, olives, and shrimp cocktail. The bounty of fun food is the backdrop to an all-American day.

  Except that, more likely than not, much of the food on the burdened picnic table isn’t “American” at all.

  Those hamburgers are a don’t-ask-don’t-tell compilation of beef leftovers shaved from higher-quality cuts of meat in slaughterhouses ranging from Uruguay to Canada. By the time those beef patties arrive at the grocery store, they may each include bits and pieces of a couple of foreign nations, not to mention a half-dozen U.S. states.

  The strawberries in the salad bowl may have come from as far away as Chile, conditions unknown, or from farm fields of dubious operators in Mexico where produce furrows float on rivers of garbage-strewn irrigation waters. The pineapples hail from Thailand, the clementines from Spain, the grapes from any number of Latin American exporters.1

  The shrimp on the cocktail platter may trace back to volatile Gulf of Mexico waters made alternately famous and infamous by New Orleans chefs and contaminated seafood beds. But much of the shrimp consumed by Americans is now grown at aquatic farms in China and other cheap-labor nations of Asia.

  If the cheese selections include queso fresco, then that unpasteurized delicacy hails from proud and sometimes risky cultural traditions in Mexico.

  Scattered throughout and sprinkled on top of anything from the picnic hummus bowl to the varietal olive snacks are spices ranging from Santo Domingo hot peppers to Sri Lankan cardamom.

  Contamination from every one of those foods has government inspectors and university food safety experts worrying about imports more and more each year.

  The Centers for Disease Control and Prevention in 2012 released a five-year study of foodborne illness outbreaks from imported goods, and they found statistics heading in a troubling direction. Fifteen different nations sent food to the United States that resulted in outbreaks of pathogens, with the rate increasing markedly in the last two years of the study.2 The thirty-nine foreign-food outbreaks caused 2,348 illnesses, with nearly half of implicated food coming from Asian shippers. Pathogens in fish caused the largest number of import-related outbreaks, with the next largest group caused by various spices.

  The pressure of massive imported food volume pressing against the tenuous FDA and USDA inspection screens is relentless, and growing. A surprisingly self-critical report from the FDA in 2011 detailed the rising wave: 80 percent of the seafood consumed in America was already coming from imports.3 Americans want strawberries in January, oranges in November, and bananas all year long—in certain seasons, 60 percent of the produce being sold in U.S. grocery stores comes from farms abroad. All told, up to 15 percent of all the food eaten in America is coming from overseas imports, and that will accelerate. The FDA report put future growth at about 15 percent per year. We want those strawberries, but we also demand they come cheap, as the power of consumer choice goads giant retailers such as Walmart, Costco, and Safeway into ruthless negotiations with suppliers to provide cut-rate goods. “The manufacturers and producers that FDA regulates face intense pressure to lower costs and improve productivity,” the agency said.4

  Food, drugs, medical devices, and other imported items regulated by the FDA are referred to in port-of-entry business lingo as “lines”—crates of pineapples from a ship are one “line” of goods on a customs and inspection invoice, while frozen shrimp from the adja
cent cargo hold constitute another “line.” A food industry consultant and former FDA official estimated the number of imported “lines” the agency sees coming in each year have shot from about five million a few years ago to more than thirty million.5

  This extension of the U.S. food pipeline around the world has often occurred well out of sight and certainly out of mind for the American consumer. We call for instant availability of anything we might want to eat, and overwhelming choice, without thinking there might not be quite enough apple trees in Washington state to satisfy our craving for apple juice at a hotel buffet in early March. Food toxicologist Robert Buchanan, head of the University of Maryland’s food safety program, likes to quiz people from outside his trade exactly where they think their chosen meal originated.

  The number one producer of apple juice is China, he noted, followed by Chile and then Germany.6 Orange juice, though, must be an all-American item, what with those friendly commercials from Florida growers in overalls and the abundance of trees in the citrus belt, right? The number one producer of orange juice is Brazil, Buchanan demurs, providing nearly half of the billion liters of orange juice imported into the United States each year. A brief panic over a banned fungicide found on Brazilian oranges sent juice futures spiking and had regulators scrambling to rethink their system in early 2012—U.S. food safety officials found traces of a mold inhibitor barred on U.S. farms but allowed in Brazil.7

  Think about it another way, Buchanan suggested, with the help of any household globe. If you want to know where your food is coming from, just put a finger on the tip of South America at the beginning of the southern summer in December, then trace northward at two-week intervals as the prime growing season follows the sun. By the time you’ve hit Alaska, you’ve covered half the globe, and farmers and distributors operating under a near-infinite variety of food safety conditions.