“Once again, we must ask ourselves how foodborne disease can develop in 76 million residents of one of the world’s most technically advanced countries each year, causing 350,000 hospitalizations and 5000 deaths and adding $7 billion to our health care costs, despite intensive regulation of food production and distribution.”
Writing in the New England Journal of Medicine Perspective for March 5th, in Coming to Grips with Foodborne Infection — Peanut Butter, Peppers, and Nationwide Salmonella Outbreaks, Dennis G. Maki offers a series of prescriptions for the maladies of the American food distribution system.
He explains that “enormous shifts in food production during the past half century underlie the increased risk and complexity of foodborne disease caused by bacterial enteropathogens originating in food animals in North America. Today, virtually all food consumed domestically is grown and processed on a vast industrial scale or, increasingly, is imported: milk and complex dairy products, eggs and egg products, fresh vegetables and fruits, and the processed snacks and condiments incorporating these foodstuffs. Relatively little of the fresh food we eat is now grown or produced locally. Moreover, Americans like to eat out, and the risk of foodborne disease is considerably higher with food prepared in restaurants than with meals made at home.” In consequence, “with centralized production and transcontinental distribution of commercially produced foods, unusually heavy contamination of a basic foodstuff or a failure to remove contaminants in a single production step can result in the shipment of contaminated food to millions of consumers.”
“To those who believe that the solution is a return to a pastoral, early-20th-century model with millions of small farms producing more ‘natural’ food, I would point out that even if the millions of farm workers who would be required were available to produce food on a quasi-boutique scale, the costs would be enormous; it would be impossible to feed 300 million Americans, let alone the rest of the world. Efficient, industrialized production of huge quantities of food is an inescapable necessity to avoid food shortages and global famine. The challenge is to enhance the quality and safety of industrially produced food.”
Maki suggests a number of substantive changes to enhance our ability to prevent the spread of foodborne pathogens:
“Meeting this challenge will mean building on the success of the USDA’s Pathogen Reduction, Hazard Analysis, and Critical Control Point (HACCP) program, which was launched in 1996, the same year as FoodNet, a program of more intensive surveillance of foodborne infections in 10 states, and PulseNet, a system for pulsed-field gel electrophoresis DNA subtyping of enteric pathogens identified in US clinical laboratories. The HACCP program needs to be scientifically validated and applied more consistently at all stages of food production — actions that might have prevented the current salmonella outbreak. A nationwide expansion of FoodNet could improve the surveillance of documented foodborne disease, but more timely, electronic central reporting (which as done now requires nearly 2 weeks) and expansion of our national program to an international scale are required to permit more effective investigation of disease clusters. PulseNet’s pathogen subtyping should be accelerated, and the program should be integrated with similar efforts in other countries.
“We need more effective programs for monitoring the production and processing of food (including imported food) and assessing its safety. Inspections of food producers and processors by state agencies, the FDA, and the USDA have been limited by insufficient personnel and inadequate budgetary support. Safer food will come only when the federal government commits the resources needed to achieve it. We also need to develop rapid and more sensitive molecular methods for detecting enteropathogens in food, both during processing and in random sampling of final products, and programs applying these technologies need to be developed and implemented for high-risk foods.”
Nor, according to Maki, are these the only measures which should be taken. One is the pervasive use of barcoding technology: “Requiring bar codes indicating the provenance of all commercial foods would permit immediate tracing of a food item to a specific farm, processing plant, or distribution center. Such a system could have greatly accelerated the resolution of the salmonella outbreak traced to Mexican peppers. Consumers have the right to know the origin of their food, which should be stated on the label of every fresh, perishable food item.” Another step is to alter present animal feeding practices, to include “an international moratorium on the incorporation into animal feeds of growth-promoting antibiotics, which have been linked to greatly increased antimicrobial resistance in bacterial enteropathogens recovered from human infections and may weaken animals’ resistance to colonization by enteropathogens. Similarly, we should aim to eliminate all unnecessary use of antimicrobial agents in both human and veterinary medicine.”
And finally, Maki argues that “we already have the capacity to improve food safety by adopting a technology that can protect against safety breakdowns during production, preparation, or cooking: routine irradiation of the final commercial product in the case of poultry and hamburger, processed foods containing eggs or milk, and selected leafy and other vegetables eaten raw could greatly reduce the incidence of bacterial foodborne disease. Research has shown that irradiation kills pathogens or markedly reduces pathogen counts without impairing the nutritional value of food or making it toxic, carcinogenic, or radioactive. Food irradiation has been endorsed by the World Health Organization, the CDC, the FDA, the USDA, the American Medical Association, and the European Commission’s Scientific Committee on Food and is already used in many other countries. In the United States, irradiation of fresh meat has been allowed since 1997; last August, the FDA approved the irradiation of iceberg lettuce and spinach. The CDC has estimated that irradiation of high-risk foods could prevent up to a million cases of bacterial foodborne disease each year in North America. I believe it is time to launch a major effort to gain public acceptance of irradiation of high-risk foods. It is time to stop reliving history.”