Outbreak: Foodborne Illness and the Struggle for Food Safety
Brand: University of Chicago Press
Categories: Books, Business & Money, Industries



Dimensions: 6 x 1 x 9 inches
Language: English
ISBN-10: 022661168X
Print length: 384 pages
Publication date: April 16, 2019
ISBN-13: 978-0226611686
Edition: First
subtitle: First Edition
author: Visit Amazon's Timothy D. Lytton Page search results Timothy D. Lytton
review: Editorial Reviews Review "Outbreak is immensely valuable not only for scholars of food law and food safety but also for those interested in the broader fields of regulatory and administrative law." -- Diana R. H. Winters ― Journal of Legal Medicine "In Outbreak, Lytton gives us a legal scholar’s superb analysis of how government, lawyers, and civil society are struggling to prevent the tragic and unnecessary illnesses, hospitalizations, and deaths caused by microbial food contaminants. Foodborne illness may seem like an intractable problem, but Lytton’s suggestions for dealing with it are well worth attention, as is everything else in this beautifully written, thoughtful, and readable account. I couldn’t put it down." -- Marion Nestle Published On: 2019-01-02 “A remarkable sweeping overview and evaluation of food safety practices that well serves both experts working in the field and members of the general public interested in the problem of food safety. Lytton shows how major outbreaks have prompted a variety of changes to reduce the risk of foodborne illness. Yet, as he argues persuasively, we don’t have firm scientific knowledge as to the degree to which—if at all—most of these measures have actually achieved their goal.” -- Stephen Sugarman, UC Berkeley School of Law Published On: 2019-01-02 “From swill milk to HACCP to FSMA to Blockchain, Lytton weaves a compelling biological story of how we feed ourselves and the interplay between the supply chain, regulation, media, and civil litigation.” -- William D. Marler, Esq., The Food Safety Law Firm "This book fills a critical gap, weaving the history of public health, regulatory agencies, and the food industry together with issues of immediate concern today. It is an innovative perspective that captures the complexity of the system beyond the scientific report or published regulation. The book should be of interest to students and practitioners of public health and food science and anyone interested in making food reliably safe." ― Emerging Infectious Diseases "Lytton seeks to shine a light into some of the more dimly lit corners of the U.S. food system’s safety checks and balances...the book provides a history and analysis of the country’s food safety system. Lytton gives particular attention to business-to-business elements in the U.S.system, including private audits and liability insurance." -- Coral Beach ― Food Safety News "There is plenty of sage advice for the fresh produce industry in the pages of Timothy D. Lytton’s latest book." ― Azzule Systems Blog " Outbreak: Foodborne Illness and the Struggle for Food Safety is necessary reading for anyone in the produce industry (or any other) who has anything to do with food safety." ― Produce Blue Book About the Author Timothy D. Lytton is a distinguished university professor and professor of law at Georgia State University College of Law. He is the author, most recently, of Kosher: Private Regulation in the Age of Industrial Food . Excerpt. © Reprinted by permission. All rights reserved. Outbreak Foodborne Illness and the Struggle for Food Safety By Timothy D. Lytton The University of Chicago Press Copyright © 2019 The University of Chicago All rights reserved. ISBN: 978-0-226-61168-6 Contents 1 Trouble in the Fields An Introduction to the Food Safety System, 2 The Gospel of Clean Milk Dairy Sanitation, Pasteurization, and the Origins of the American Food Safety System, 3 Canned Foods under Pressure HACCP and the Dynamics of Food Safety Reform, 4 Building a Better Burger How Media Coverage and Civil Litigation Facilitate Policy Change, 5 Making Salad Safe Again GAPs and the Complex Network Structure of Food Safety Governance, 6 Bean Counting The Challenges of Assessing Food Safety Efforts, 7 From Fork to Farm Honing the Tools of Outbreak Investigation, 8 Recipes for Reform Supporting Evidence-Based Food Safety Governance and Improving Private Oversight, 9 Food for Thought Reflections on Complexity, Uncertainty, and Evolution, Appendix A How Researchers Estimate the Number of Cases and Economic Costs of Foodborne Illness, Appendix B Legal Doctrines Governing Liability for Foodborne Illness and Litigation Dynamics, Appendix C The Origins of Third-Party Food Safety Auditing in the United States, Appendix D The Politics behind the California Leafy Greens Marketing Agreement, List of Abbreviations, Timeline of Significant Events, Acknowledgments, Notes, Index, CHAPTER 1 Trouble in the Fields: An Introduction to the Food Safety System The family farms of Rocky Ford, Colorado, enjoy a well-deserved reputation for producing exceptionally flavorful cantaloupes. The surrounding Arkansas River Valley offers ideal conditions for melon cultivation — hot days and cool nights that enhance the plants' sugar production. But in 2011, cantaloupes from this region attracted attention for a different reason. They were the source of one of the deadliest food poisoning outbreaks in US history. Eric and Ryan Jensen, two hardworking brothers in their mid-thirties, raised and packed cantaloupes ninety miles east of Rocky Ford. Fourth-generation melon farmers, the brothers inherited 160 acres from their father and expanded their operations to 6,000 acres. During the 2011 harvest, Jensen Farms produced three hundred thousand cases of cantaloupes, labeled "Sweet Rocky Fords," which were sold through a distributor to leading retail supermarkets, such as Walmart, Kroger, and Safeway. Many of these melons were contaminated with a virulent bacterial pathogen, Listeria monocytogenes, and they caused 147 reported cases of serious illness and thirty-three deaths in twenty-eight states. No one has ever conclusively identified the source of the contamination. One possibility is organic fertilizer. At the time of the outbreak, the brothers were in the midst of a three-year process of converting their operations from conventional to organic production, which requires replacing mineral fertilizers and chemical pesticides with alternatives derived from plants and animals. From a business perspective, the brothers sought to profit from the growing consumer demand for organic fruits and vegetables. They also had a deeply personal reason for the shift. Their father, Robert Jensen, had died in March 2010, at the age of fifty-nine, from cancer, which the brothers suspected might have been caused by pesticide or other chemical exposure. They believed that organic production would redeem Jensen Farms from decades of synthetic fertilizer and pesticide application. However, organic fertilizers also pose risks to human health. If not properly treated, they can harbor microorganisms, including bacterial pathogens such as Salmonella, E. coli, and Listeria. The Jensen brothers were not unmindful of the risk of bacterial contamination. They began post-harvest processing by immersing the melons in a dunk tank filled with chlorinated water to remove dirt and reduce harmful bacteria on the surface of the fruit. The melons were then dried, packed into crates, placed in cold storage, and later shipped to a distributor for sale to retail stores. In August 2010, a private food safety auditor inspected the fields and packinghouse operations, awarding Jensen Farms a score of 95 percent and a "superior" rating. When one of the brothers asked how they could improve their processing, the auditor responded that the dunk tank, with its recirculating water, was a potential food safety "hot spot" and that they should consider replacing it. The following spring, with advice from a local equipment supplier, the brothers purchased and installed spray-washing equipment originally designed to clean potatoes and modified for melon processing. The new equipment used non-recirculating city water to wash the melons as they passed along a conveyer belt. A subsequent July 2011 audit awarded Jensen Farms a score of 96 percent and another "superior" rating. The audit report noted that the spray wash system "does not have anti-microbial solution injected," but this was not characterized as a deficiency, nor did it detract from the audit score. To the Jensens, the new non-recirculating spray wash system appeared more sanitary than the old dunk tank, which became increasingly dirty during the course of each production run. However, without antimicrobial solution added to the wash water, the spray wash spread bacterial contamination from melon to melon and dispersed it all over the processing equipment. By late August, Colorado health officials began receiving reports of individuals suffering from listeriosis. On September 2, they notified the federal Centers for Disease Control and Prevention (CDC) of seven cases in the state. Within a week, state and federal investigators traced the source of the outbreak to Jensen Farms cantaloupe. Four investigators arrived at the farm on September 9 and 10 to collect samples. Tests confirmed that samples taken from Jensen Farms melons, equipment, and facilities contained the same pathogenic strains of Listeria as those found in recently reported cases of listeriosis. The Jensens immediately ceased shipment of their cantaloupes and destroyed their remaining crops, and on September 14, the company voluntarily ordered a seventeen-state recall of its melons. The recall came too late for forty-eight-year-old Shelly Occhipinti-Krout, who left behind a husband and three children when she died from listeriosis, which she contracted from eating Jensen Farms cantaloupe. "It started with just flu-like symptoms," her daughter Tiffany recalls. "Then she collapsed ... and was taken to the hospital. While she was getting a CAT scan, she went into cardiac arrest, and doctors put her into a medically induced coma." After three weeks in the hospital, her body was so swollen from the infection that she was unrecognizable. "I kept thinking that she was going to come home," says Tiffany. "She went like a normal person to the grocery store, got her stuff, came home, and ate it. From that my mom got sick, and I'm never going to see her again." Eighty-seven-year-old William Beach also died of listeriosis from eating Jensen Farms cantaloupe. "He was in and out of the hospital several times," remembers his wife, Monette. "About a month before he died, we were in the living room watching TV one night, and he said, 'Honey, we've got trouble; there is something wrong with me, and I don't know what it is.'" In the hospital, when doctors attempted to insert a feeding and medication tube, he began to hemorrhage through his mouth and nose. William eventually succumbed to the infection. "The bottom line here is that my father died because somebody didn't do their job," says William's daughter Debbie, expressing a view held by many victims and their families. "I think it's unconscionable. All of us hope that when we go it's quick. But never, ever, do we ever think that it's going to come with us spewing blood out of our mouth and our nose in terror because we don't know what's going on but we know it's over. Somebody's responsible for it." In the end, public health authorities attributed 147 reported cases of listeriosis to tainted cantaloupes from Jensen Farms. Thirty-three victims died within weeks of consuming the melon, and another ten died months later, possibly as a result of the infection. Some of those who survived sustained brain injuries and other long-term disabilities. Victims and their families were left with large medical bills — in several cases exceeding a million dollars. Researchers at the CDC in Atlanta estimate that "48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases each year in the United States." (For a detailed account of how researchers estimate the number of cases and the economic costs of foodborne illness, see appendix A .) These statistics have led many commentators to declare the food safety system "broken" and in need of significant reform. A report by the US Public Interest Research Group analyzing outbreaks and recalls in 2011 and 2012 concludes that foodborne illness caused by microbial contamination "has stayed stagnant and potentially grown worse, taking a substantial toll on public health and the economy," and that "the rules and inspection systems we have now are not up to the task." Not everyone agrees that outbreaks signify that the system is broken. Even highly effective regulatory programs tolerate a certain amount of risk. There will always be some residual risk in the food system — zero risk is simply not possible. As one food safety professional with more than thirty years of experience in the poultry sector puts it: "People who demand bacteria-free eggs just don't understand where they come from — there's only one way out of the chicken." Nor is zero risk a desirable goal, because at a certain point, the costs of additional risk reduction would outweigh the benefits. Tom Vilsack, secretary of agriculture in the Obama administration, expressed a view widely shared within the food industry when he boasted in 2012 that, although there is admittedly room for improvement, the United States has the world's "safest food supply — an achievement made possible by a wide range of skilled, dedicated people." Leaving aside for the moment the question of how well the food safety system performs, available data suggest that foodborne illness in the United States is a problem of noteworthy magnitude comparable to other common sources of illness and injury that have attracted the attention of public health authorities. (The analysis that follows relies on data drawn from a variety of sources, collected using various methods, and covering different years. Some of the numbers represent direct tallies from health records, while others are estimates that rely on surveys and statistical models. The aim is to provide general perspective not precise comparisons.) By using the CDC estimate, figure 1.1 shows that annual deaths from foodborne illness are far fewer in number than those caused by tobacco smoking, obesity, and alcohol use; considerably fewer than those caused by poisoning, motor vehicles, and falls; comparable to those caused by drowning, fire, and natural disasters; and significantly greater than those caused by machinery, firearms, cycling, and cutting and piercing. Figure 1.2 compares the estimated number of hospitalizations from foodborne illness to those from leading sources of injury. Although hospitalizations from foodborne illness are fewer than those of the top three sources of nonfatal injury — falls, poisoning, and motor vehicle accidents — they exceed several other leading sources, such as burns, cutting and piercing, natural disasters, firearms, cycling, machinery, and drowning. Figure 1.3 suggests that the estimated number of foodborne illness episodes involving acute illness far exceeds that of other leading forms of unintentional injury. Using estimates from researchers at the US Department of Agriculture (USDA) Economic Research Service, figure 1.4 compares the cost of medical care due to foodborne illness and leading forms of illness and unintentional injury. The medical costs of foodborne illness rank below those of tobacco smoking, obesity, falls, cycling, alcohol use, motor vehicle accidents, and poisoning, but they exceed those of burns, drowning, and firearms. The burden of foodborne illness falls most heavily on the elderly, who are at greatest risk of death or severe complications. Half of the reported listeriosis cases in the Jensen Farms melon outbreak were among individuals older than seventy-seven years, and most who died were older than eighty. In a 2011 report on foodborne illness caused by major pathogens, the CDC found that 13 percent of infections, 24 percent of hospitalizations, and 57 percent of deaths occurred among adults sixty-five or older. Thus, the elderly not only face a higher risk of infection; they are also far more likely to suffer serious illness and death as a result. Young children and those who are immunosuppressed — for example, cancer patients receiving chemotherapy — also face a higher risk. Another way to evaluate the significance of foodborne illness is to consider public perceptions. Survey data suggest that consumer concern about food safety may be growing. A 2012 survey of US consumers by an industry-funded organization called the International Food Information Council found that 18 percent of respondents reported that they were "not too" or "not at all confident in the safety of the US food supply," a number that rose to 30 percent in a subsequent 2014 survey. In this latter survey, the council also found that "two out of five Americans [38 percent] have changed the foods they eat as a result of food safety information" and that a "third [34 percent] of Americans consider getting sick from something they eat as their most important food safety issue." A 2010 survey by the federal Food and Drug Administration (FDA) found that 35 percent of respondents characterized contamination of food by microorganisms as a "serious food safety problem." Of course, there may be a gap between perceived and actual risk. Public concern may be driven more by media coverage of outbreaks than by careful risk analysis. Nevertheless, in the context of democratic politics and competitive markets, if voters and consumers believe something is a big problem, then for elected officials and companies it is. Moreover, even leading food safety experts, who frequently lack hard data to support their policy prescriptions, rely on their risk perceptions, which are influenced by dramatic outbreaks, value-laden choices about priorities, and general views about the proper role of government in risk regulation. Food safety, says Marion Nestle, a leading voice on food policy, "is a highly political issue." This book attempts to describe how the US food safety system works. The topic is large and unwieldy for a number of reasons. First, food safety encompasses a broad array of issues, including concerns about microbial pathogens, food additives, pesticide exposure, antibiotics in animal feed, chemical contamination, foreign objects, and genetically modified organisms. Second, the food industry is not one but many different industries, each with its own history, culture, modes of production, and methods of distribution. Making broad generalizations about "the food industry" on the basis of the production of fluid milk, ground beef, or leafy greens is likely to obscure more than it illuminates. Third, efforts to reduce the risk of foodborne illness involve a dizzying array of government officials at the federal, state, and local level; industry managers in farming, animal husbandry, transportation, food processing, product distribution, retail supermarkets, and food service operations; and assorted consumer advocates, lawyers, and insurance companies — all of whom bring a wide variety of perspectives from agriculture, veterinary science, microbiology, biochemistry, food technology, management, law, and underwriting, and who employ multiple tools, including law enforcement, supply chain management, and civil litigation. The book focuses exclusively on efforts to reduce foodborne illness caused by microbial pathogens such as bacteria and viruses. Concentrating on this slice of the food safety system allows for exploration of the system's complexity without getting overwhelmed by it. The aim is not to discount the importance of other food safety issues but to avoid biting off more than one can digest. For the same reason, the book focuses on the US food safety system rather than adopting a global or comparative perspective. The book discusses global institutions where they directly influence the US food safety system, and readers will find much in this analysis of the US system that is useful in understanding food safety regulation in other countries. Each chapter of the book presents a case study of an outbreak in a different sector of the food industry as a means of exploring a particular aspect of the food safety system. Each chapter drills down in one place into the system with the hope that, by the end of the book, they will together support a broad perspective on the system as a whole. A closer look at the story of the Jensen Farms cantaloupe listeriosis outbreak — from three different angles — will introduce readers to the various actors and their roles within the system. After fleshing out more details of the story, this first chapter introduces some general themes of the book and offers a brief overview of the chapters that follow. Government Regulation Indications of the listeriosis outbreak eventually traced to Jensen Farms cantaloupe first appeared in late August 2011. Alicia Cronquist, a Colorado health department epidemiologist in charge of foodborne illness investigations, received reports from doctors' offices and medical labs of seven cases of Listeria infection within one week. State law requires physicians and labs to report all cases of certain medical conditions, including listeriosis, to state public health authorities. Typically, the state health department receives reports of one or two listeriosis cases per month. "Clearly, we were on high alert," recalls Cronquist. She immediately commenced an investigation. Bacterial samples collected from patients' blood and cerebrospinal fluid were sent to a state laboratory specially equipped to identify the particular subtype, or strain, of Listeria using a process that reveals the bacteria's DNA profile. When two patients are infected with the same strain, this suggests a common source of infection. Lab results revealed that each of the seven listeriosis patients was infected with one of three strains. As it is possible for the same food item to harbor multiple strains, it remained unclear at that point whether the investigators were dealing with one outbreak from a single source or simultaneous outbreaks from different sources. The labs uploaded test results from all the samples to PulseNet, a national database administered by the CDC, which catalogs the DNA profiles of bacterial infections throughout the country. CDC epidemiologists matched the three Listeria strains from patient samples in Colorado with identical strains from cases reported concurrently in several other states, including Nebraska, Texas, and New Mexico. (Continues...) Excerpted from Outbreak by Timothy D. Lytton . Copyright © 2019 The University of Chicago. Excerpted by permission of The University of Chicago Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site. Read more