As Turkey Day approaches, animal lovers cringe, food safety advocates become vigilant and industrial turkey producers hope you aren’t reading the news.

Specifically, the purveyors of factory farm turkeys hope you haven’t heard about the latest turkey salmonella outbreak in 35 states, causing 63 hospitalizations and at least one death.

According to the Centers for Disease Control and Prevention:

The outbreak strain of Salmonella Reading has been identified in various raw turkey products, including ground turkey and turkey patties. The outbreak strain has also been found in raw turkey pet food and live turkeys, indicating it might be widespread in the turkey industry.”

Factory farm turkey producers also hope you’ve forgotten that avian flu and its prevention killed so many turkeys in 2015—at least 7.5 million—that turkey giant Jennie-O laid off 233 workers.

They hope you’ve forgotten that scientists at the Bloomberg School’s Center for a Livable Future and Arizona State’s Biodesign Institute found Tylenol, Benadryl, caffeine, statins and Prozac in feather meal samples that included U.S. turkeys—“a surprisingly broad spectrum of prescription and over-the-counter drugs,” said study co-author Rolf Halden of Arizona State University.

And finally, Butterball hopes you’ve forgotten that several of its employees were convicted of sickening animal cruelty and that veterinarian Dr. Sarah Mason admits tipping off Butterball about an imminent raid by Hoke County detectives to investigate the abuse.

Can consumers rely on labels to make good buying decisions? Not really.

Many consumers rely on labels to help them avoid serving a sick, contaminated or abused bird on Thanksgiving Day. Unfortunately, navigating the maze of labels and marketing claims is at best time consuming, and at worst, a waste of time. For example, “cage free” and “hormone free” are meaningless since cages and hormones aren’t used (or at least, aren’t supposed to be used) in turkey production anyway.

Nor does “young” mean anything—all turkeys are young at the time of slaughter. They live only a matter of weeks or a few months.

And don’t even get us started on turkey labeled “natural,” “all natural” or “100% natural.” As Organic Consumers Association and other food safety and animal welfare groups wrote in a letter last year to Cargill:

We are concerned about the production and marketing of Cargill’s turkey products. In particular, we believe that Cargill is misleading consumers about (1) its systematic overuse of antibiotics and other contaminants, which can pose a threat to public health; (2) whether its turkey products, and animal husbandry practices, are “natural;” (3) whether its turkey products emanate from facilities that employ inhumane agro-industrial practices; and (4) whether its turkey production practices are “environmentally conscious.”

Here’s a long list of facts you’ll never see listed on the major turkey brands in your grocery store.

1) Ractopamine is still in use

Hormones may not be used in turkey production but ractopamine, the asthma-like growth enhancer used to quickly add muscle weight to factory farm turkeys is. Banned in 160 countries and widely viewed as dangerous to animals and humans, ractopamine was approved by the U.S. Food & Drug Administration (FDA) for use in turkey in 2009, under the brand name Topmax. It has never been labeled.

How dangerous is Topmax? This is what its label says: “NOT FOR HUMAN USE. Warning. The active ingredient in Topmax, ractopamine hydrochloride, is a beta-adrenergic agonist. Individuals with cardiovascular disease should exercise special caution to avoid exposure. Not for use in humans. Keep out of the reach of children… When mixing and handling Topmax, use protective clothing, impervious gloves, protective eye wear, and a NIOSH-approved dust mask. Operators should wash thoroughly with soap and water after handling.” There’s even an 800 number for emergencies.

Monkeys fed ractopamine in a Canadian study “developed daily tachycardia” (rapid heartbeat). Rats fed ractopamine developed a constellation of birth defects like cleft palate, protruding tongue, short limbs, missing digits, open eyelids and enlarged hearts.

In its new drug application (no longer on the FDA website), Elanco, ractopamine’s manufacturer, admitted that ractopamine produced “alterations” in turkey meat such as a “mononuclear cell infiltrate and myofiber degeneration,”  “an increase in the incidence of cysts” and differences, some “significant,” in the weight of organs like hearts, kidneys and livers.

2) Antibiotics and antibiotic-resistant bacteria are found in turkey

Antibiotics are widely used in turkey production to produce weight gain with less feed, and to stop disease outbreaks from crowded conditions. In fact, when the FDA tried to ban the use of one class of antibiotic—cephalosporins—in 2008, Michael Rybolt, the National Turkey Federation’s director of scientific and regulatory affairs, said, “To raise turkeys without antibiotics would increase the incidence of illness in turkey flocks.”

Referring to 227-acre turkey operations as “small family farms,” Rybolt said antibiotics were actually green because the use of antibiotics means less land is required to grow feed, less land is required to house turkeys—and less turkey feed means there is less manure.

Not all antibiotics used in U.S. industrial turkey operations are legal, suggests research by scientists at the Bloomberg School’s Center for a Livable Future and Arizona State’s Biodesign Institute. They found fluoroquinolones in eight of 12 samples of feather meal in a multi-state study. Fluoroquinolones are antibiotics used to treat serious bacterial infections in humans, especially infections that have become resistant to other antibiotic. Fluoroquinolones have been banned for livestock use since 2005.

Why do the government and all leading medical groups condemn routine, daily use of antibiotics in livestock? Because it encourages the development of antibiotic-resistant bacteria which cause potentially lethal infections in people.

Almost half of turkey samples purchased at U.S. grocery stores harbored antibiotic resistant-infections, according to a 2011 report in the Los Angeles Times. A serious strain of antibiotic-resistant salmonella called Salmonella Heidelberg and Salmonella Hadar forced recalls of turkey products from Jennie-O Turkey. The resistant salmonella strains were so deadly, officials warned that the meat should be disposed in sealed garbage cans to protect wild animals. Even wildlife is threatened by the factory farm-created scourges.

More recently, Consumer Reports issued a lengthy report on the widespread presence of antibiotics and drugs, some banned for use in livestock production, in meat, poultry (including turkey) and pork.

3) Drugs used to treat turkey diseases pose threats to human health

Industrially produced turkeys are at risk of many diseases for which both medicines and vaccines are administered. Until 2015, an arsenic-containing drug called Nitarsone was FDA-approved for the “first six weeks of a turkey’s 20-week life span.” Three other arsenic products were rescinded by the FDA in 2012.

It’s shocking that arsenic has been allowed in U.S. poultry production for almost 50 years, given that increasing evidence supports that chronic low-to-moderate exposure results in numerous non-cancerous health effects, including cardiovascular, kidney and respiratory disease, diabetes and cognitive and reproductive defects,” according to a scientific paper published in 2016, in Environmental Health Perspectives. Inorganic arsenic is an established human carcinogen, known to cause cancers of the lung, skin and bladder and possibly cancers of the liver and kidney.

Turkeys can suffer from Aspergillosis (Brooder Pneumonia), Avian Influenza, Avian Leucosis, Histomoniasis, Coccidiosis, Coronavirus, Erysipelas, Typhoid, TB, Fowl Cholera, Mites, Lice, Herpes, Clostridial dermatitis, Cellulitis and much more—and the treatments are often as scary as the conditions. Consider, for example, the anti-coccidial drug halofuginone which the Federal Register says “is toxic to fish and aquatic life” and “an irritant to eyes and skin.” Users should take care to “Keep [it] out of lakes, ponds, and streams” says the Register. A few years ago, scientists even found the endocrine disrupter Bisphenol A (BPA) in fresh turkey.

4) Animal cruelty abounds in industrial turkey production

Even before 2015 bird flu outbreak that resulted in turkeys being euthanized by suffocation in a way even producers called cruel, industrially produced turkeys had tragic lives.

Unable to mate because of the huge chests they are bred to have (many barely able to walk), producers use a cruel artificial insemination technique, which involves “milking” the males and forcing the semen into the hens. Veterinary journals admit that using chemicals to make turkeys grow abnormally fast puts the birds at risk for “sudden death from cardiac problems and aortic rupture,” (diagnosed by the presence of large clots of blood around the turkey’s lungs) hypertensive angiopathy and pulmonary edema. Growth drugs in turkeys may also “result in leg weakness or paralysis,” says the Federal Code.

Because turkeys are drugged and bred to grow so quickly, their legs can’t support their own weight and many arrive with broken and dislocated limbs, a “live hanger” who worked undercover at House of Raeford Farms in Raeford, N.C., the seventh-largest turkey producer in the U.S. , told me a few years ago. When you try to remove them from their crates, their legs twist completely around, offering no resistance he told me. “The turkeys must be in a lot of pain but they don’t cry out. The only sound you hear as you hang them is trucks being washed out to go back and get a new load.”

And then there’s this: The kill conveyer belt at the slaughterhouse moves so fast, turkeys miss the “stunner” that is supposed to render them insensate, resulting thousands of birds being boiled alive.

While some food safety and animal rights activists have sought to find turkey producers who do not commit such practices, others warn that so-called ethical producers may be disingenuous.

“Our birds live in harmony with the environment and we allow them plenty of room to roam,” says a Diestel Turkey Ranch brochure, displayed at Whole Foods meat counters. But Slate reported in 2015 that a visit to Diestel’s Jamestown facility, conducted by Direct Action investigators, “revealed horrific conditions, even by the standards of industrial agriculture.” Turkeys were jammed into overcrowded barns, trapped in piles of feces, had swollen eyes and open sores and “dead turkeys [were] strewn across the barn floor.”

Clearly there is a lot that turkey producers, even the so-called “humane” ones—don’t want you to know.

Want to avoid factory farm turkeys this holiday season? Here are a few tips.

Martha Rosenberg a freelance journalist and frequent contributor to the Organic Consumers Association (OCA). Katherine Paul, associate director, contributed to this article. To keep up with OCA’s news and alerts, sign up here.