March 18, 2001
Contaminated Food Makes Millions Ill Despite Advances
By GREG WINTER
Tapeworm and botulism have been all but eradicated in this country, and new technologies from freeze-drying to irradiation have been developed to make food safer. But because of changing eating habits and more choices of foods, Americans may be more likely to get sick from what they eat today than they were half a century ago.
The frequency of serious gastrointestinal illness, a common gauge of food poisoning, is 34 percent above what it was in 1948, according to the Centers for Disease Control and Prevention. Not all scientists agree with that conclusion some say that food poisoning is as common as in the immediate postwar years, but not necessarily more so, yet there is no doubt about the scale of the problem. Every year, the agency says, 5,000 deaths, 325,000 hospitalizations and 76 million illnesses are caused by food poisoning.
One of those sickened was Taylor Lake Holt, a cheerful 7-year-old boy from Anchorage. Taylor, a cancer patient who had just ended a yearlong ordeal with chemotherapy in 1999, celebrated with a smoothie made with unpasteurized Sun Orchard orange juice. Within a day, he had to be rushed back to the hospital, where it took him four more days to recover. The juice, it turned out, contained salmonella.
The company later explained that it had met rising demand by bringing from Mexico a tanker truck of unpasteurized orange juice, chilled with contaminated ice. The company and regulators agree that this probably caused an outbreak that infected more than 400 people. One elderly man died.
Why, in an age of technologies that protect food, is food poisoning at least as common as it was a half- century ago? For one thing, people are eating more fresh fruits and vegetables without cooking them, increasing the chance of infection through bacteria or viruses. For another, people are eating more precooked foods, like seafood salads and deli meats, which are more dangerous than traditional sit-down meals served right off the stove or out of the oven. What is more, the variety of foods available has expanded considerably faster than the government's ability to inspect them. In the last decade, grocery stores have doubled the number of items they stock, from every corner of the world, some carrying new organisms that scientists still cannot identify, much less treat. In fact, the amount of contaminated food that reaches store shelves only to be recalled for posing health risks has reached its highest level in more than a decade. "We do have a real problem," said Joe Levitt, food safety director for the
Food and Drug Administration.
Amid the proliferation of foods, the F.D.A.'s resources to scrutinize them have scarcely changed, often making consumers the first to test a product's safety. A healthy person can withstand most infections, but older people have weaker immune systems and the population is aging, leading many scientists to worry that more Americans are becoming more susceptible to food-borne illness.
"We are the canaries in the coal mines," said Dickson Despommier, a professor at the Mailman School of Public Health at Columbia University. "The moment someone gets sick, we say, 'Don't eat that food.' It's a miracle that the system doesn't break down more." Unappealing though they may be, many contaminated products recalled last year, from batches of moldy Gatorade to ammonia-tainted ice cream, do not pose serious threats to health, manufacturers say.
When outbreaks do occur, the food industry adds, better surveillance has quickened the ability to track down the cause, helping to make the nation's food supply, already the safest in the world, more trustworthy than ever. And the industry says it has made much progress in making food safer. In fact, the illnesses caused by contaminated juice came in spite of stringent new F.D.A. rules for the juice industry in the wake of earlier outbreaks. And Sun Orchard, an Arizona company, had already increased safety by steam-cleaning oranges and bathing them in chlorine to kill bacteria.
Although much of the fear surrounding food safety focuses on meat and poultry, especially beef, the General Accounting Office estimates that 85 percent of food poisoning comes from the fruits, vegetables, seafood and cheeses that are regulated by the F.D.A. and claim a larger share of the American diet each year. And poisoning from such foods can be every bit as deadly as that from meat and poultry. Still, the F.D.A. has less than a tenth of the inspectors of the Department of Agriculture, which regulates the meat and poultry industry. So while
U.S.D.A. inspectors examine meat before it gets to grocery freezers, the
F.D.A. must increasingly rely on the companies it regulates to keep their factories clean and their products safe. Now, with slightly more than 400 inspectors to ferret out violations in 57,000 plants across the nation, the F.D.A. inspects food manufacturers about once every eight years. Some health officials, consumer advocates and epidemiologists doubt that without more of a presence the F.D.A. can catch contaminated food at the source and prevent it from getting into the food supply. "The F.D.A. is simply going from crisis to crisis and attempting to put out the fires," said Caroline Smith DeWaal, food safety director for the Center for Science in the Public Interest, a nonprofit group.
The critics have some evidence. Last year, recalls of F.D.A.-regulated products rose to 315 the most since the mid-1980's and 36 percent above the average since the agency began keeping track 15 years ago. In every instance, the food had already made its way to store shelves before any contamination was discovered, either by regulators or by manufacturers, and often remained there for months. "Any reasonable person would worry about it," said George Grob, deputy inspector general for the Department of Health and Human Services, which oversees the F.D.A. "If the inspection process worked really well, there would be fewer recalls. That's why you do inspections: to prevent any contamination from occurring in the first place." In contrast with its strict supervision of blood banks or mammography centers, the F.D.A. is not required to visit food plants regularly. And as the agency's workload has increased faster than its budget, particularly in the realm of approving new drugs, food safety inspections have fallen to about a third of what they were in the 1980's.
"The core mission of the agency, which has been to inspect food and ensure its safety, has eroded," said one senior Health and Human Services official. With imported foods, the F.D.A. is at a particular disadvantage. In the last four years alone, the number of foreign food items increased by 50 percent, from 2.7 million items in 1997 to 4.1 million last year. The responsibility of examining that avalanche falls to a cadre of just 113 federal import inspectors, and the force has grown by only 3 workers since
1997. As a result, the F.D.A. inspects less than 1 percent of all imported foods, according to the General Accounting Office. It is all but inevitable, health officials say, that at least some of those imports will be contaminated. Last April, a California bean sprout grower, Pacific Coast Sprout Farms, shipped in seeds from China and Australia. Germinated in warehouse- sized shelters, the sprouts caused a salmonella outbreak from Oregon to Massachusetts. At least 67 people fell ill, 17 of whom sought treatment in hospitals.
Not only were the imported seeds contaminated, health officials say, but the company grew them using only a tenth of the amount of cleansing agent recommended by the F.D.A. And although the company found evidence of contamination before sending the sprouts to market, it did not order a recall until after an outbreak had spread. The C.D.C. now says that food is responsible for twice the number of illnesses in the United States as scientists thought just seven years ago. Many of the illnesses stem from improper handling of food, either by kitchen workers or consumers themselves, but some health officials say this has always been the case and, if anything, treatment of food has improved over the years. At least 80 percent of food-related illnesses are caused by viruses or other pathogens that scientists cannot even identify.
As for the diseases researchers do know, while a number of common ailments like salmonella have tapered off in recent years, other, more serious illnesses appear to be on the rise. Cases of E. coli infection, for example, have more than doubled in the last five years, to 4,341 in 2000 from 1,667 in 1995, although some of the increase may be a result of better reporting, scientists say. The food industry agrees that better scrutiny is needed, because not all companies can afford to run tests in their factories. "Right or wrong, the vast majority of foods are not required to be tested for pathogens," said
C. Thomas Leitzke, director of inspections for the Wisconsin health department. "The plants are not required to do it, and in most cases don't." Many health officials worry that as consolidation transforms the food industry from countless local farms to a handful of giant corporations that ship their products worldwide, the reach of contaminated food is expanding, magnifying problems when they do occur. "Even if you doubled the number of inspectors, you still only look at a small percentage of the food," said Dr. Dennis Lang, infectious disease officer at the National Institutes of Health. "But the mere promise that it might be inspected makes people take notice. They'll make sure their plant is clean."