Category: Health & Disease

  • Food Safety – The US Policy Dimensions of HR 875 and HR 759

    Food Safety – The US Policy Dimensions of HR 875 and HR 759

    ith the recent spat of recalls surrounding pistachios and peanut butter in the US, there has been a large response from the public to better safeguard the food supply. Industry is also starting to warm up to the idea because the cost of recalls are enormous. Food lawyer Bill Marler puts the cost of just the peanut recall alone at $1 billion dollars.

    The cries for change come amid another small scale outbreak observed in April 2009 regarding alfalfa sprouts in the NE US (follow the link for more information from the FDA).

    With all this tainted food floating around the food supply, the US congress says it wants change. The first step towards change has been the now familiar hearing between corporate officers and a Congressional subcommittee. You can see some of the testimony about the salmonella outbreak in peanuts here:

    Out of these meetings has come different ways to address the public’s concerns. Here we review some of the options currently being discussed against the wisdom of some leading food safety professionals.

    HR 875

    The most hyped up pronouncement from Congress has been HR 875. Introduced by Rep. Rosa DeLauro (D-Conn), the Food Safety Modernization Act of 2009 is a response to all the food safety crises that have happened in the first part of this year. The bill has gotten a lot of press in the last couple weeks and most of it has been negative.

    Red State – Blue State, together on HR 875

    All political ideologies seem to be enraged by this bill. The far left sustainable agriculture crowd is noticeably upset that the bill lumps together factory farming operations with local agriculture, making everyone submit to the same rule set. The far right group Reason asks about HR875′s impact on the ability to farm for yourself. This bill was also prominently featured in many of the politically right ‘Tea Parties‘ that happened on tax day.

    Both sides seem to focus on just one provision in the legislation – Section 3, Article 14, where a food production facility is defined so broadly as to encompass everything from a dairy farm to your mother’s backyard. From the bill:

    “(14) FOOD PRODUCTION FACILITY- The term ‘food production facility’ means any farm, ranch, orchard, vineyard, aquaculture facility, or confined animal-feeding operation.”

    DeLauro came on the Huffington Post to defend her motives and dissuade some of this bad press, claiming the far right was responsible for a disinformation campaign. She essentially argues all these fears are bogus because the commerce clause of the US constitution – the one that allows the US congress to regulate trade in the first place – only applies to interstate trade, not hyper-local farms and neighborhood gardens. (Unfortunately, that strict constructionalist view of the constitution has not been upheld by the Supreme Court, so DeLauro, et al. would need to formally make a provision for them in the legislation to get passed this political impasse.)

    The senator also posted a rebuttal to all this criticism on her own website. You can view it here:

    A Way Forward?

    Once you get beyond the political dimension, the big takeaway from HR 875 is that it would split the FDA into two new government agencies. A ‘Food Safety Administration‘ would be formed inside of the existing Department of Health and Human Services (HHS) and be in charge of all things food while the FDA would largely turn into a ‘Drug Administration‘ with each new agency holding exclusive sway over their own fiefdoms. This is radical departure from the current system which uses a patchwork of provisions in many agencies across the government.

    This dual agency approach is largely applauded by the farming activist circuit, despite all the bad press this bill has gotten. Food and Water Watch tentatively agree with the position and so do the Trust for America’s Health + Robert Wood Johnson Foundation but problems still remain with this approach.

    Many food safety functions are carried out by the USDA and since HR 875 only addresses the FDA, most meat products (beef, fish, chicken, etc) would languish inside of our old system. Not to mention, the local dimension to food safety remains noticeably absent in HR 875, as no specific provisions for that group are included.

    H.R. 759

    The other major bill before Congress is H.R. 759The Food and Drug Administration Globalization Act of 2009. This is a different approach at fixing food safety by modifying the FDA extensively, giving the agency far more authority to conduct inspections and take action based on what it finds while keeping it intact. But, in an even deeper blow to local farming, the rules of HR 759 apply generally to all size farms and restaurants, which obviously tips in favor of large-scale farming. Even worse, the FDA’s increased surveillance costs are shouldered by the very farmers they are evaluating. Parts of the bill get extremely complicated in how these fees are determined but here is a sample from the top section:

    SEC. 741. FACILITY REGISTRATION FEE.

    ‘(a) In General- The Secretary shall assess and collect a fee for a facility registration under section 415 to defray increases (as described in subsection (f)(2)(A)(ii)) in the costs of inspecting establishments registered under section 415 and for related activities to ensure compliance by such establishments with the requirements of this Act relating to food (including increases in such costs for management of information, and the acquisition, maintenance, and repair of information technology resources).

    Some of the language is so vague that local farmers might have reason to be concerned. These fees very wildly depending on what kind of an operation each farm and restaurant turn out to be; later in the bill it explains how these fees scale – a process that will likely see great change in the sausage maker of Capitol Hill. Additional costs from this bill are also substantial inside each farm and restaurant, as it extends electronic bookkeeping to these establishments for the first time.

    Money, money, money

    In this bill’s implementation, all of these fees are heavily tilted toward industrialized, large scale agriculture. These fees will likely be a far lower percentage of their gross income; think of these fee provisions as regressive farm taxes. With closer inspection, HR 759 looks far more dangerous to local farming than HR 875 – and because it takes a more pragmatic approach to revising the FDA, Food and Water Watch thinks it has a much better chance of passing.

    Other Dimensions

    Leading researchers from The George Washington University take a different path than any of these bills. They advocate for a similar system to HR 875 (link is a long read) but even more extensive, pulling departments from other agencies like the CDC and the USDA into the fold. They still concentrate food safety into the HHS department in their excellent position paper. Here are some of the major ideas from the paper:

    “Congress should direct the Secretary of HHS to create, in collaboration with the states, a National Foodborne Illness Data Program.”
    “Congress should establish and fund an intergovernmental Food Safety Leadership Council
    (FSLC) through which the federal government would collaborate with state and local
    governments to design and implement an integrated national food safety system”
    “Congress should establish traceability requirements that permit federal, state, and local officials to rapidly obtain from food companies reliable information on the source of commodities, ingredients, and finished products.”

    The way they advocate for local involvement is far different from any federal approach, and it appears to be based on good research evaluating how the system currently works in the real world.

    What’s Next?

    Connecting a new food safety system to existing local agencies appears to be a crucial step most of the currently pending approaches before the Congress fail to address. Most recalls start on a local level so those stations need to be able to coordinate a response with federal officials, especially considering just how global the food supply is now. Other best practices safety implementations like the HACCP system Marion Nestle passionately supports need to be incorporated into whatever final legislation is adopted.

    Who is in charge of me?

    There is also the question of how phytochemical plant-based supplements/drugs would fall in this dichotomy. Right now, the FDA regulates food supplements very loosely, while putting many screws to any drug that claims to treat or prevent a disease. A semantic tip-toe has existed within these fields for years; the main difference between drugs and supplements is that supplements are directly sourced from food and herbs while drugs are proprietary creations from pharmaceutical companies. While there is already a supplement regulation act (however flawed it is), an expanded FDA or revised dual-headed Food Agency/Drug Agency setup could seriously change how we view this category of products – and it is a huge industry now. This issue could get very contentious.

    One thing is clear though – our current food safety system is not working. We need something better and if you read our last piece on food safety, you know many interested parties have been advocating for just such an overhaul for more than 20 years. Now is clearly the time as the public is finally focused on the issue. Many good ideas are floating around but just as many bad ones are as well. Let’s hope Congress is listening to the roar on the internet from HR 875 and they include protections for small scale agriculture.

  • Food Safety – The Recent History

    Food Safety – The Recent History

    he early part of 2009 has witnessed one of the largest food contamination cases in US history.  The Peanut Corporation of America had a salmonella outbreak in one of their factories, contaminating the majority of peanut-butter containing products in the United States.  Unfortunately, this outbreak is not an isolated incident across the industry.

    E.coli O157:H7, Listeria, Staph and Campylocbacter cause millions of bacterial infections every year.  The prevalence of these pathogens relates directly to how food arrives into your home today – a process that has radically changed over the last 20 years.   Here, we review the recent history of food borne illnesses and how they relate to the consolidation of the food industry.

    Food Borne Illness

    Contaminated foods are far more common than you probably think.  Estimates suggest as many as 1 in 4 Americans, about 75 million people, suffer from food borne illness once every year while another 350,000 less fortunate people are hospitalized and 5,000 die.  People typically associate food contamination with meat – and for good reason.  The frantic hand-washing after handling most meat products strikes some as reactionary but it makes more sense when you see the numbers.

    Chicken Contamination in 2007

    Consumer Reports ran a large study, testing 525 raw chickens in early 2007 and found a stunning 83% of all chickens were infected with salmonella or campylobacter bacteria.  Even more alarming, the majority of both bacteria’s tested were resistant to one or more antibiotics – largely resulting from the factory farm practice of giving their birds a constant, low level of antibiotics to retard hunger. [1]

    All this is made worse by the dramatic consolidation of poultry slaughterhouses in the last 20 years, pushing ever greater numbers of chickens into tight spaces – the ideal environment for disease.  We could spend all day making the connection between factory farming and pathogens in food but that’s for another article.  The problem of food contamination goes way beyond meat products – they are only part of this story.  Before, we really get going, here is a primer video with the food safety czar Dr. Marion Nestle:

    The most recent fiasco with peanut butter better explains many of the other issues involved.

    Peanut Butter Under the Microscope

    The speed with which the peanut butter fiasco unfolded speaks volumes as to what we are up against with the way our food system is put together and ensuring its safety.  On January 16th 2009, Kellogg’s recalled some of their Austin brand peanut butter sandwich crackers at the request of the government.  Within a week, 130 more products from all sorts of manufacturers had been recalled.  By the end of the month, 19,000 people in 43 states had been sickened and 8 had died from complications.

    No bacteria in the shell

    With a little investigation, the FDA and CDC found the entire outbreak could be traced to one plant in Georgia owned by the Peanut Corporation of America.  It may be hard to imagine that one single plant could contaminate a good majority of the entire nation’s supply of peanut butter in under a month but that seems to be what happened here.

    To better understand how this could happen, the Times ran a great piece last month that starts to scratch the surface into the realities of the modern food system.  This is an excerpt from that piece that talks about inspections briefly but you will get the idea (emphasis mine):

    “Plant employees said they typically had advance knowledge of state inspections and that last month, when they were tipped off that federal investigators were coming, the employees were told not to answer questions. Where the state had found no major problems, the federal team found many, like the leaky roof, and swab tests showed salmonella living on the plant floors. Plant managers had not decontaminated the peanut butter processing line after detecting salmonella, the federal report shows.

    In examining Peanut Corporation of America’s records, federal investigators discovered that company tests had found salmonella 12 times since 2007. The inspectors said they got the records by invoking a bioterrorism law.”

    Conflicting standards, a lack of funds, lax oversight and carelessness were all apart of this salmonella epidemic.  The Peanut Corporation of America may be the poster child for all of this but similar practices surely go on elsewhere due to the exact same circumstances that created this situation.   The reality is that it is very hard for any of us – including the safety regulators in charge of this operation – to know where the next firestorm will erupt.   Looking back shows us an almost identical set of circumstances that led to the last major outbreak prior to peanut butter – spinach.

    Spinach Is Food Safety in a Nutshell

    The e.coli O157:H7 outbreak in pre-washed spinach back in late 2006 was the last poster child for food safety reform.  The incident was widely covered in the media, excellent news pieces were authored about the problems – especially the eerily prophetic article published in the Washington Post, whose last line concluded “Unless something changes, we will have another outbreak.

     

    Extent of Spinach Outbreak, CDC

    Tainted spinach fully captured the national spotlight when the CDC first made public the problem.  From their first bulletin (emphasis mine):

    “Public health officials in multiple states, with the assistance of the Centers for Disease Control and Prevention, are investigating a large outbreak of E. coli O157:H7 infections. Thus far, 50 cases…have been reported from CT (1), ID (3), IN (4), MI (3), OR (5), NM (2), UT (11), WI (20).  Eight patients developed the hemolytic uremic syndrome (HUS) and one patient died.  Most cases are recent: for those with known illness onset, the range of onset is 08/25/2006 to 09/03/2006.  The outbreak is likely ongoing.”

    What’s important to note here is that by the time the first bulletin was issued, we were already dealing with contamination from coast to coast.  Essentially, the problem was nationwide before anyone even started to do anything about it.

    A quick response by government agencies mitigated the damage but still almost 200 people feel ill and 3 died as a result of the outbreak according to the CDC.  Follow up reports on the incident get us even closer to understanding just how intertwined our food system is now.

    The CDC worked with local California officials and conducted their own investigation into the exact source of the contamination.  Their findings suggested a nearby cattle farm who leased part of their land out to a spinach farm had runoff that was contaminated with the same genetic strain of e.coli that sickened large parts of the country.  Also suggested was that maybe a single wild pig may have run through the cattle manure and then the spinach.

    Reused water likely spread e.coli across America

    How could a single pig contaminate the entire nation’s spinach crop?  Surprisingly, it was quite easy.  Prepared spinach is ‘washed’ in water that gets reused over and over and over again.  It is assumed that the equipment and water are sterile but if one pathogen gets in, it easily spreads through the entire system.  After the spinach was bagged and trucked away, you can easily see how just one little pig sickened 200 people from coast to coast.

    Understanding the Centralized Food System

    Food safety issues are more important now because the concentration of food production in the United States has increased substantially over the past 20 years.  The USDA published an insightful look at the US food production landscape back in May 2007 – and its results highlight just how concentrated most food related activities are today.

    The report mostly focused on consolidation in food retailers – like the move from traditional supermarkets into warehousers like Sam’s Club – but it also found that food production and distribution  consolidated at a remarkable clip.

    How food production has concentrated, USDA

    Just in the period from 1997-2002, nearly every major food industry saw its four largest firms grow far larger.  Cookie makers, water distributors, seafood purveyors and milk producers saw their rates of consolidation climb anywhere from 10-100%.  Additional consolidation was seen in both the cattle and hog industries mentioned further down in the report.   In short, agribusiness is slowly becoming the de facto method of food production – and that means new controls are urgently needed.

    Tying the Pieces Together

    With dramatic uptakes in food industry consolidation, more and more of our food is coming from fewer and fewer places.  As we saw with both the peanut butter and spinach incidents, just one plant or one field can now contaminate the entire country in mere days.  Consequently, food safety becomes a bigger issue because there is a greater likelihood for contamination at every step.  Higher density farms, big processing plants and warehouse food retailers put massive amounts of ingredients together in ways whose ramifications we are only beginning to comprehend.

    While smaller food brands, organics and farmer’s markets have grown at a strong clip, they are nowhere near offsetting the dramatic consolidation going on inside the agribusiness industry.  Stronger food safety measures, like the agreement the California Leafy Green growers instituted after the spinach ordeal, need to be put into place everywhere.  It should not take outbreaks in each food group for proper food safety measures to become the norm, but, without an overarching national food safety framework, massive liability has been the only successful tool in motivating agribusiness to secure the food supply.  Here’s hoping things are a bit different this time around.

    NOTEThis article is the 1st part of a series about Food Safety in the United States. You may want to read the first part to better understand this article:

    Part 1: Book Review: Safe Food by Marion Nestle

  • Integrative Medicine on Capitol Hill

    Integrative Medicine on Capitol Hill

    On Thursday, the US Senate Committee on Health, Education, Labor and Pensions held a hearing called, Integrative Care: A Pathway to a Healthier Nation to assess how complementary medicine will be incorporated into President Obama’s challenge for Congress to pass health care reform in 2009. Barbara Milkulski (D), Maryland and Tom Harkin (D), Iowa chaired the committee that invited a distinguished panel of famous complementary practitioners to report their findings from field work.

    The proceedings can be see in their entirety here:

    Dr. Mehmet C. Oz, Director, Cardiovascular Institute and Complementary Medicine Program, New York-Presbyterian Hospital, New York, NY was the first speaker (minutes 27-33). His speech to the committee was based upon the idea of movements where Oz advocated having patients become their own advocates in the health care system. His proposal included four points:

    • 1. Create a Smart Patient Movement, where people learn how to take of themselves before needing medical intervention
    • 2. Massively upgrade the information systems surrounding health care to be upgraded to systems like Microsoft HealthVault and Google Health – where patients store their medical records for all types of health professionals to see.
    • 3. Establish a ‘culture of wellness’ – defined as giving patients a more total platter of options in how they want to be healed. Physicians would be joined by ‘Health Coaches’ – people like physical therapists, social workers and acupuncturists – who help people become healthier before they need reactionary, Western medicine.
    • 4. Expand his ‘Health Corps Movement’ – a program is based upon the concepts of Peace Corps, whereby passionate young adults tutor their peers, in schools, on becoming more healthy.

    Following Dr. Oz was Dr. Mark Hyman, Founder and Medical Director of The UltraWellness Center in Lenox, MA – (watch minutes 68-74 in the video).

    Dr. Hyman

    Hyman’s major point was an affront to most of the medical community – that the entire system and approach to modern disease is completely wrong. Because most of the health crises in American revolve around chronic diseases, the reactionary, allopathic model of medicine is outdated. He wants a system that proactively addresses the debilitating symptoms of chronic disease before they ever form. From his speech [emphasis mine]:

    We must address the underlying causes of illness and chronic disease. If we, give the wrong type of care, we will simply be doing the wrong thing – better. [We need to change not] only the way we do medicine but the medicine we do. This new paradigm of functional medicine is a system of personalized, patient-centered care based on how our environment and lifestyle choices impact on our genes to create imbalances in our genes and biologic systems….It is the best solution to our health care system.”

    Continuing with Dr. Oz’s point, Dr. Hyman hammered on the point of the need for health coaches to assist doctors in creating a healthy environment. He outlined three major initiatives he wanted to see in Obama’s upcoming health reform act:

    • 1. A radical shift in public investment towards training and research facilities that proactively address the needs of chronic disease, with the US creating a federal training center.
    • 2. Expand already existing and proven functional medicine projects, compromised of doctors and other health professionals, that demonstrate a new model of care.
    • 3. Create a White House cabinet position that coordinates all of these functions.

    Next up was Dr. Dean Ornish, Founder and President, Preventive Medicine Research Institute, Sausalito, CA (minutes 78-82) who mainly reinforced the points made by earlier speakers, adding that the systems he has implemented show impressive cost reductions. He stated that 75-80% of all medical costs are now related to chronic diseases – heart disease, obesity, diabetes – and that he was able to eliminate almost 95% of those costs with functional medicine approaches.

    Dr. Weil

    Finally, Dr. Andy Weil, Arizona Center for Integrative Medicine, University of Arizona, Vail, AZ (minutes 82 – 92) turned his focus onto why medical costs are so high in America. He made the point that our high tech medical system costs so much that there is no possible way to treat the numbers of sick people present without a different approach. He advocated low, very low tech medicine – simple breathing techniques and laughing – as examples of therapies he uses on a regular basis. He was adamant on changing the culture around alternative therapies with proper education.

    Thoughts…

    The Q&A afterwords between the doctors and senators involved the nagging question of how to make these changes happen. It was distressing to see just how little of an idea this important regulatory body had in terms of what they should be doing to improve health. Consistently, throughout this hearing, you would see the panel of health professionals imploring the senators to use the doctors’ collective talents.

    But it strikes us as so odd that – as these doctors talked with the exact group responsible for implementing these policies – yet none of the senators take notes or have drafts of the necessary legislation on hand to amend with new ideas. All of this genius is sitting before them, unloading mountains of brilliant – and often proven – ideas as these legislators just sit and watch when it is they who have the responsibility to act on this information.

    Hello? Is anybody home? Oh…you are busy with lobbyists. Sorry to interrupt.

    Each one of these CAM advocates made the case for prevention and better information preventing diseases before they happen, and they did it eloquently. Each outlined a path to this new world of health care, demonstrating the numbers and how this should be the way forward. They made concrete recommendations – a White House level voice for wellness, re-educating health professionals at medical schools, implementing health coaches and expanding the Health Corps – that could have immediate effects. Dr. Hyman’s presentation was one of the best speeches on the subject we have ever heard.

    Seeing as this conference was focused on helping craft the complementary medicine portion of health care reform, it is regrettable, if not inexcusable, that these senators – on the health subcommittee no less – could not even start to show how they will implement the wisdom bestowed upon them at this hearing. The time for discussing these issues has long passed and action is urgently needed. Functional medicine is used by millions every day but the American system of medicine discourages its use at every turn. It is our hope a few of the people on the government’s side watching this presentation could synthesize just 1% of what was being said to them and craft it into meaningful policy.

    Read each presenter’s official submitted statements to the committee: