Consequences of Europe's E. Coli Outbreak

MS. DIANE REHM

10:06:54
Thanks for joining us. I'm Diane Rehm. The E. coli outbreak in Europe has heightened concerns about food safety here in the U.S. The CDC estimates, every year, 48 million Americans are sickened by food borne disease. Three thousand die. A new food safety law was passed in December, but Congress failed to provide funding to enforce it.

MS. DIANE REHM

10:07:29
Joining me to talk about the E. coli outbreak in Europe and food safety: Gardiner Harris of The New York Times, David Orden of Virginia Tech and the International Food Policy Research Institute and Jeff Benedict. He's the author of a new book on E. coli titled "Poisoned." Throughout the hour, we'll take your calls, 800-433-8850. Send us your email to drshow@wamu.org. First, we're joined by phone from Frankfurt, Germany, Laura Stevens of The Wall Street Journal. Good morning, Laura.

MS. LAURA STEVENS

10:08:20
Good morning.

REHM

10:08:21
You know, we keep hearing changing reports. At first it was thought that the bean sprouts were the cause of the outbreak. And, now, I gather that's changed.

STEVENS

10:08:37
Yes. Initial testing does appear to show that the bean sprouts are not responsible, but they are continuing testing. As you know, there's been several fingered foods at this point. They've pointed to cucumbers from Spain, which turned out not to be the source.

STEVENS

10:08:56
Now, they've looked at bean sprouts in Germany, which they first identified yesterday as the possible source because several people who had eaten those bean sprouts had also dined at several restaurants that seem to be connected to the outbreak. And they tied this all together and thought that that might be one of the potential sources. It's a small bean sprout farm in northern Germany and supplies bean sprouts to most of northern and central Germany.

REHM

10:09:24
Does Germany have the means to sufficiently detect what might be the cause of such an outbreak?

STEVENS

10:09:37
They're doing everything they can. I'm not sure if -- I mean, they're definitely trying really hard to track every clue that they can. They're interviewing all the patients. It seems like it's a very difficult thing to track because you have to go to all the different ports to any place that fresh vegetables or fruits have been imported to, looking at different sources that could potentially have spread this infection to so many people.

STEVENS

10:10:07
So I think they're doing the best they can, and they're trying really hard to track every clue and to determine what is causing this.

REHM

10:10:16
Give us a sense of how big a deal this is in Europe on television news, in newspapers. How are people reacting?

STEVENS

10:10:27
It's definitely a big deal. Almost everybody I know have stopped eating raw fruits and vegetables, especially tomatoes, cucumbers and lettuce and, now, bean sprouts as advised by the German health ministry. And, yeah, it's been in every newspaper. It's on every news program. It is definitely a huge topic of news here. And, plus, you can't avoid it. When you go out, there are signs in restaurants. You know, everybody's talking about it. It's definitely a big deal.

REHM

10:10:56
So how has business in restaurants, and even grocery stores, been affected?

STEVENS

10:11:05
I was actually in Homburg for the weekend. And there, they've definitely been hit really hard. That's where the outbreak is thought to have started. They saw the first cases of this deadly strain there. And every restaurant pretty much that you go into, there's a billboard saying that they're not going to be serving vegetables there. That strikes half the menu items from some of their menus, some owners told me.

STEVENS

10:11:27
You also go into a bakery. There are no vegetables, no tomatoes on the sandwiches there, which has really hurt sales for them. You go to a farmer's produce stand, and they're not selling any cucumbers, any tomatoes. They've cut the prices from 3 euros a kilo for tomatoes to 1 euro a kilo for tomatoes. And they're just not able to sell any of it. So it's having a huge economic impact.

STEVENS

10:11:51
For German farmers alone, they've estimated 30 million euros a week. And then multiply that times restaurants, grocery stores, produce stands, and you start to get an idea of how big this is.

REHM

10:12:02
And do we know, at this point, how many countries in Europe have been affected?

STEVENS

10:12:10
Yes. Apparently, 11 other countries have seen some form of people who are sickened by this, including the U.S. actually. They've had four travelers who are in Homburg for a trip, come back and have become infected with this strain. Most of the cases do stem from northern Germany or traveled to northern Germany, so it's definitely a German problem still. But it is spreading throughout Europe, and even one Swedish woman has died.

REHM

10:12:39
Laura Stevens of The Wall Street Journal, thank you so much for joining us.

STEVENS

10:12:45
Thank you.

REHM

10:12:47
And turning to you now, Jeff Benedict, explain exactly what E. coli is and how it makes people sick.

MR. JEFF BENEDICT

10:12:57
Well, the simplest way to think of E. coli is they're bacterial germs. And there are hundreds of them. We get them in our intestinal tract a couple days after we're born, and they're harmless. We all have them. Warm-blooded animals have them. Birds have them. But there's about six or seven strains of E. coli that are out there that are lethal if they get inside a human's intestinal tract.

MR. JEFF BENEDICT

10:13:20
And they typically come in through food or water. They're waterborne or food borne. The most common one that we're familiar with in the United States and probably in the world is H1:O757, (sp?) which we learned about through Jack in the Box and hamburgers back in the early '90s. When we had our outbreak, which was very similar to this one in terms of blindsiding us, we didn't know about E. coli, really, as Americans or consumers prior to that.

MR. JEFF BENEDICT

10:13:44
It shocked us, and it caused us to really wake up to -- here's a strain that, if it gets in our food, can be deadly. But, today, there's at least six, and now if you look in Europe, you could say a seventh strain that's out there that's just as deadly, just as sickening if it gets in our food supply.

REHM

10:14:02
A brand-new strain, David Orden?

PROF. DAVID ORDEN

10:14:06
I'm going to refer to the scientific experts on the strains of E. coli and stick to the economic issues and the trade issues myself.

REHM

10:14:13
Okay. Jeff.

BENEDICT

10:14:15
I think it's fair to say it's new. That's what the experts are saying. It appears to be a mutation of one of the six strains that we've already known about that's in our food. We call them the big six. They're the six strains that we don't test for in the U.S. today, and we don't inspect for them. And we should. This strain could be -- make it the big seven because it's a form of one of the six we've known about. But it appears to have some different features.

BENEDICT

10:14:38
And I think that's one of the reasons they're having trouble, you know, really getting their hands around what is this that we're dealing with.

MR. GARDINER HARRIS

10:14:44
So, Diane, it's not new. It's rare. It has -- it was -- it actually was the source of an outbreak last year in the Republic of Georgia. There was a case in the literature in Korea of a patient coming down with hemolytic-uremic syndrome with this. So it is rare, but it's not like it hasn't been seen before. And there are some concerning aspects to it. It's a particularly virulent strain.

MR. GARDINER HARRIS

10:15:12
And it seems that there are sort of odd things in there that it's actually, for instance, antibiotic resistant -- not that that matters to the patients -- but it suggests that there might be -- that the reservoir where this bacteria is growing could be in feed animals, for instance. Because why would they be resistant to antibiotics? It could be that it's, you know, antibiotics are widely used in pigs.

MR. GARDINER HARRIS

10:15:38
They're widely used in cattle. There are going to be some really interesting aspects to this outbreak when -- if and when we finally find out where it's from.

REHM

10:15:50
Gardiner Harris, he is science reporter for The New York Times. Jeff Benedict is author of "Poisoned: The True Story of the Deadly E. coli Outbreak That Changed the Way Americans Eat." David Orden is professor at Virginia Tech Institute for Society, Culture and the Environment. Tell me why, if you understand this, why is it so difficult to trace the origin of something like this?

REHM

10:16:27
I mean, Gardiner was talking about animals, but this is a -- apparently coming through something that's grown in the soil.

ORDEN

10:16:38
Well, we've done pretty good in the United States in tracking pathogens, particularly E. coli pathogens. And I think -- and the reason we haven't had a major outbreak in the last 18 years since Jack in the Box was because we learned some lessons in that case. And one is, you know, we've set up all kinds of protocols and procedures. We share information now. Every state health department and the CDC are connected.

ORDEN

10:17:01
Germany apparently doesn't have those steps in place like we do. Now, that doesn't mean that we couldn't get blindsided like this again. But at least one strain of E. coli, we've got a really good grip on it, and we track it fast. I think the danger for us, Diane, is that these other six strains that we know are in our food system, we don't have good tracking devices for because the USDA hasn't declared them as adulterants.

ORDEN

10:17:24
And so health officials don't test for them. Food inspectors don't inspect for them. And yet they're in our food.

REHM

10:17:31
Go ahead.

HARRIS

10:17:32
Yeah, the only reason why we know this stuff happens, Diane, is that people get sick, right?

REHM

10:17:36
Right.

HARRIS

10:17:37
I mean, what you really want, obviously, is a system that checks the food before you actually eat it. But in our system and nearly all over the world, that's not what happens, that you find these things out once people get very sick. And think about what happens when you feel like you got sick by something. You know, what share of the time do you go to the doctor? Probably a very small share. You know, you get diarrhea. You get a fever.

HARRIS

10:18:01
Now, it's only when your diarrhea actually turns bloody, which is when you get into sort of a dangerous situation, that for many people they will actually go to the doctor. Now, many doctors in that situation -- and this is the wrong thing to do -- they'll simply give you an antibiotic, send you home and say, you know, you'll probably get over this. But, you know, if you have bloody diarrhea, that is a serious health event, and you need to do more than that.

REHM

10:18:26
Gardiner Harris, he's science reporter for The New York Times. When we come back, we'll talk about how E. coli is typically transmitted from person to person as well as the total economic effects. Right back.

REHM

10:20:03
And here's our first email from someone with very personal experience. Wendy in Charlotte, N.C., says, "I had a child who had E. coli poisoning and, more dramatically, HUS," which you mentioned...

HARRIS

10:20:21
Right.

REHM

10:20:22
...Gardiner. "We were living in Gaithersburg, Md. He became so sick, he had to be transported to Fairfax, Va., for a higher level of care than our community hospital could handle. We spent close to a month in the hospital, receiving large amounts of blood transfusions. He was actually put on dialysis..."

HARRIS

10:20:46
Right.

REHM

10:20:48
"...when I read about this story. I can't imagine how any health care system can possibly handle the number of HUS cases they are reporting." Explain what HUS does, Gardiner.

HARRIS

10:21:04
Well, what happens when you get one of these toxic E. colis -- you know, as Jeff said, there are hundreds of E. coli. In fact, there's good evidence that we can't live without them. But there are some E. coli that produce what is called a Shiga toxin, and it's -- and what happens is that these E. coli have, like, a stickiness to them. And they go into your gut, and they stick to the walls of your gut.

HARRIS

10:21:28
And then, in your gut, they produce this poison that then gets absorbed into your bloodstream. The E. coli doesn't go into your bloodstream, but the poison does. Once in your bloodstream, this poison then starts to attack the small, tiny capillaries distributed throughout your body. And the place where these capillaries are most sort of concentrated is in your kidneys because your kidneys, obviously, serve to filter your blood.

HARRIS

10:21:56
And so what happens is that these poisons create a sort of heart attack for your kidney. Your kidney basically shuts down, and that, of course, is a life-threatening event. You'll get -- hopefully, your kidneys will eventually recover. But during this period of time, you may need to get dialysis. And there, obviously -- some people never do recover and die.

REHM

10:22:19
Well, and that is her last question. "Does the need for a high level of care mean more or most of the HUS patients will die?" Jeff.

BENEDICT

10:22:32
Well, if you look at history here in the U.S., Diane, the thing that shocked health care officials in the Jack in the Box case was, all of a sudden, there were all these kids who showed up. And the number of HUS cases was rising by the day. They didn't have enough kidney dialysis machines in Children's Hospital in Seattle to treat them. They were literally shipping in machines from around the country 'cause there were so many kids who needed dialysis.

REHM

10:22:54
Explain that Jack in the Box case.

BENEDICT

10:22:57
Well, the situation there was -- it's Seattle. It's 1993, and, all of a sudden, a dozen or so kids show up over a weekend in Seattle Children's Hospital with severe bloody diarrhea and cramping. It's weird because it's January. And this disease, at that time, was thought to only occur in the summer when people are barbecuing hamburgers. They tracked it quickly to contaminated meat.

BENEDICT

10:23:21
But, within two weeks, they were up to hundreds of kids who had this illness. And the HUS, as Gardiner was just pointing out, is -- there were a number of these kids who had the toxin release, and it started shutting down their kidneys. And it's not just kidneys, Diane. It's the liver, the pancreas, the brain and the heart. All of those vital organs are under attack when this toxin is released in the bloodstream.

REHM

10:23:44
And what's done to treat it?

BENEDICT

10:23:46
Well, the problem is what they did in that case -- and it's not uncommon -- is the kids who had the worst cases were put into medically induced comas, hoping that the organs would be able to get some recuperation. But the four kids died, where the kids that just -- even in the medically induced coma wasn't enough. And what's alarming about what's going on in Germany right now is the percentage of people of the reported cases.

BENEDICT

10:24:10
About 25 percent of them have HUS. That's an off-the-charts percentage. That either means there's a lot of cases that haven't been reported that don't have HUS, or this strain is way more virulent than what we've seen before.

REHM

10:24:24
So, David Orden, the economic impact of this is going to be rather large.

ORDEN

10:24:32
The economic impacts of these food safety scares can be enormous because people are very averse to risks they can't control. You can drive your car too fast and get a speeding ticket. You make that choice. But we need to find (unintelligible) have a safe food system's delivering a trillion dollars of food in the United States just alone, most -- almost of it coming through very complex delivery systems.

ORDEN

10:24:56
And when we get a scare like this, as you've seen in Europe, the demand for the product that's creating that scare just drops off tremendously. The industry takes a huge hit, of course, for good reason. But -- so, therefore, the industry itself has a lot of incentive to avoid these kind of scares. And that's one of the responses to the Jack in the Box, I think, was to take steps to improve our food safety system.

ORDEN

10:25:17
We've avoided some of the worst. We did -- we avoided the BSE crisis to anything like the extent...

REHM

10:25:22
The bovine...

ORDEN

10:25:24
Mad cow disease, commonly called, which also affected the human brain and killed over a thousand people. We've only had one case in the United States. One cow came down with BSE. (unintelligible) a number of countries cut off our exports of beef and continue to.

REHM

10:25:38
What happened to Jack in the Box?

BENEDICT

10:25:42
Amazingly, Diane, the company survived. And the reason they did that -- today, they're one of the most profitable fast food chains in America. They're the fifth largest now in the country. And the reason for that, Diane, is because they hired a guy named Dave Theno, who was a meat industry expert on E. coli. And he came in, joined the company, and he instituted these protocols and safety procedures that are now industry-wide.

BENEDICT

10:26:03
They're the standard. And it's a safe place to eat.

REHM

10:26:07
Gardiner, how is this E. coli transmitted?

HARRIS

10:26:12
Well, it's usually transmitted, obviously, through food. So E. coli lives in animals, right? And that's where the reservoir is. It gets into fresh fruits and vegetables through contaminated water. Actually, if it was the sprouts, you can actually get contaminated seeds, and it'll grow up in the seeds. It can get into the vegetables from the roots up. But, usually, that's because some sort of animal has walked into the field.

HARRIS

10:26:42
Or you have water that is contaminated that washes it, or something like that.

REHM

10:26:47
Can it be transmitted from person to person?

HARRIS

10:26:50
Yes. And that's...

REHM

10:26:51
How?

HARRIS

10:26:52
Well, you know, it's a somewhat dispiriting thing, especially when you have babies. But there are a lot of diseases that are obviously fecal-oral transmission. And that means that you are somehow ingesting something that came out of someone's bottom. And so this is why someone with bloody diarrhea needs to be isolated right away. They need to go to the hospital because they're not only sick themselves. They can make everybody else sick in their family.

ORDEN

10:27:21
But then it's not an infectious disease. That's important for people to know. It's not infectious.

HARRIS

10:27:22
It's not, but...

REHM

10:27:23
Yeah.

HARRIS

10:27:24
...it can be transmitted person to person. Usually, it's not going to -- you know, this is not something that's going to explode across the community. But you can get family members sick. And it is not at all unusual for one person in the family to become sick, and then the other persons in the family to become sick.

REHM

10:27:39
Here's a message from Facebook from Valerie, who says, "Please mention they have not determined if this strain of E. coli is from the bovine species. I've no problem with advocating local organic food. But it's jumping the gun if the strain is found to be causing the outbreak is from, say, a squirrel, a deer or even a feral pig."

BENEDICT

10:28:08
A quick thing on that, Diane, is just because you're getting food from an organic farm doesn't mean you never have to think about food pathogens. I mean, I'm a big proponent of organic food. That's what I eat. We even grow it on our own farm. But the fact is you still have to be careful. You still have to have safety procedures. You still got to know how the cow is milked and the beef is slaughtered, et cetera. And so it's not immunity.

BENEDICT

10:28:31
And just a quick follow-up to what Gardiner was saying about the transmission from person to person, in the Jack in the Box case, there was basically two waves of infection. There were all the kids who got sick from eating contaminated meat. But then there were a whole bunch of kids who got sick in daycare centers and places like that because they were in close contact with kids who had eaten meat.

BENEDICT

10:28:51
And they handled the diapers, et cetera, and then fingers to mouth. And suddenly you have kids, who didn't eat any hamburgers, who have E. coli.

REHM

10:28:59
What is the World Trade Organization's role in regulating the world food safety situation, David?

ORDEN

10:29:10
Well, the World Trade Organization gives individual countries enormous latitude to set their own standards for food safety and animal and plant health protection. It -- its concern is that those regulations not be used as trade barriers. And there are some cases where arguments were made that they are used to protect an individual industry or domestic industry.

ORDEN

10:29:33
But, broadly, there's wide latitude, especially for emergency measures as you might take in a circumstance like we have now -- wide latitude, individual countries are given, under the WTO, to take precautionary measures and to protect human and animal health.

REHM

10:29:48
So we are down to the question, now, of, is our food system safer than that of Germany, for example, Gardiner?

HARRIS

10:30:01
Well, that's always impossible to make those sort of comparisons. Now, the Germans have not distinguished themselves. We can sort of say that. Part of the reason is, of course, that we're seeing this in real time. Oftentimes, in outbreaks in the United States, public health officials don't actually announce that they know that there's an outbreak going on until they figure out the vector or until they figure out the source.

HARRIS

10:30:21
Because that, you know, their thinking is, why announce something when you can't give anybody information that they can work on?

REHM

10:30:26
So how did this get out so quickly?

HARRIS

10:30:29
Well, it was such a huge -- it was such a huge outbreak that they couldn't keep it in, so they had to sort of -- they had to announce that there is this huge outbreak. They announced, obviously, their suspicions. The first one was the Spanish cucumbers. That was wrong. They've been wrong, you know, repeatedly. Now, it is not unusual to be wrong. We have gone through this ourselves, repeatedly.

HARRIS

10:30:50
We've, you know, thrown out an entire crop of tomatoes when it found -- when -- and found out later that it was actually jalapenos because it was the vector. Or the thing that transmitted the salmonella, in that case, was salsa. And so it was tomato, combined with jalapenos. So it's a very difficult thing to do. The other problem, of course, is that there have been lots of reports that doctors have been trying to find the right antibiotic to treat these patients with, and that is the exact wrong thing to do in these cases.

REHM

10:31:20
Why?

HARRIS

10:31:21
Well, it's wrong because there is plenty of studies that show that you're increasing the chances of hemolytic-uremic syndrome if you give patients antibiotics. Now, nobody quite knows the reason for that. It may be that when you actually kill these bacteria in the gut, it just releases that -- a bolus of poison when you kill them.

REHM

10:31:42
Wow.

HARRIS

10:31:43
This is true also in meningococcal meningitis, which is, obviously, a terribly devastating disease. But in meningococcal meningitis, you have to do antibiotics, or the infection will go out of control. That's not the case here.

REHM

10:31:56
But, Jeff, is that something we've learned only since the Jack in the Box outbreak?

BENEDICT

10:32:03
Well, when the Jack in the Box outbreak came out on the scene in '93, fortunately, for everybody, the country's leading pediatric expert on E. coli and kidney disease was at Children's Hospital in Seattle, a Yale-educated doctor name Phil Tarr. And he knew about the dangers of administering antibiotics to kids who have E. coli. If he hadn't have been there, I think there's a really good chance...

REHM

10:32:26
Wow.

BENEDICT

10:32:27
...a lot of kids would've been given -- because it's just a natural treatment. He knew not to. He actually sent out a bulletin telling all the doctors, do not do that.

REHM

10:32:35
So what did they do? They simply put them on dialysis?

BENEDICT

10:32:39
They did a -- yeah, they did a lot of things. They put kids on dialysis. They put them in isolation, you know, liquids. There were a lot of things that they did that were wise. One other thing I'll mention is -- and that I think is really important because Gardiner touched on this a little bit-- is that there's a huge amount of pressure on state epidemiologists to declare the vector and cordon off something.

BENEDICT

10:33:03
And in Seattle, there was an enormous temptation to identify Jack in the Box earlier than they did. The problem was a lot kids in Children's Hospital in Seattle had also eaten at a bunch of other fast food chains. And if you just name one and it's the wrong one, you could kill a company that's -- that isn't responsible.

REHM

10:33:21
Jeff Benedict, he is the author of "Poisoned: The True Story of the Deadly E. coli Outbreak That Changed the Way Americans Eat." And you're listening to "The Diane Rehm Show." How do you think Americans have changed the way they eat since that outbreak, Jeff?

BENEDICT

10:33:45
I don't think it's a stretch to say that the Jack in the Box case -- it's -- in the food industry they refer to it as the meat industry's 9/11. It changed -- it was the precursor to everything from "Omnivore's Dilemma" to "Fast Food Nation" to the massive growth in farmer's markets. People started looking at food differently because, for the first time in American culture, we were told food improperly cooked or produce can kill you.

BENEDICT

10:34:10
It was like, are you -- what are you talking about? A hamburger can be lethal if it's cooked 5 degrees below a certain temperature? Yeah, now, it can be. So I think that case didn't just -- it didn't just produce all these new policies. It started to get us to start thinking about food differently. Like, it's an important part of our life, and you really need to know where it comes from and how it's grown, how it's manufactured and how it got to your fork.

REHM

10:34:34
So is the U.S. food supply safer now than it was then?

BENEDICT

10:34:41
I think it's safer now. I think the risk -- we still have outbreaks. We have outbreaks in this country every month. But they are -- typically, they're very small, and they're contained. And a lot of times, you never even read about them in the paper 'cause they're not these massive outbreaks. But one of the things, Diane, that's been done that I'm -- I don't think is good is one response of this is we treat our food with chemicals and things now that aren't considered ingredients, like ammonia in commercially sold ground beef.

BENEDICT

10:35:09
That's not an ingredient, but it's in the food. Is it going to kill you if you eat it once? No. But what's the -- to me, you got to ask. If you eat that for 20 years, if you eat a hamburger a week for 20 years, it's got that in it, is that good for your body? I mean, to me, it's not.

REHM

10:35:25
What do you think, Gardiner?

HARRIS

10:35:26
Well, I can see Jeff here wanting to get in on this. I mean, to me -- right. So what's going on, of course, is that there is an industrialization and nationalization of the food supply. So what has happened, arguably, is that a lot of these food poisoning incidents is that the share of them have actually gone down, the total number. But instead of being these small, localized spot outbreaks, you get these national outbreaks.

HARRIS

10:35:53
And they cause a huge amount of consternation. And so that's part of it. Also, I think what these things show, I think, is that, you know, is that oddly enough, the food industry wants to do something different. And, frankly, right now, Republicans on Capitol Hill are not listening to the industry. The industry -- what happens in these cases, the industry gets killed. When we've had our tomato outbreaks, $100 million in tomato get lost.

HARRIS

10:36:23
And oftentimes, it turns out that it's a very small provider who's not really following the rules. So what industry really wants right now is a very strong FDA, and they're actually willing to tax themselves to pay for it. But what's happening right now is that the Republicans on Capitol Hill, instead of increasing FDA's budget to do these new food safety laws by -- the FDA asked for $187 million.

HARRIS

10:36:47
Instead, they're going to have their budget cut by $83 million. And the Republicans are neither going to allow the industry to tax themselves, which they -- which the industry actually wants, but it's a tax. So it didn't get into the bill, nor are they going to allow FDA to get extra money from the rest of us.

REHM

10:37:03
David.

ORDEN

10:37:04
I agree 100 percent that we've brought up the Food Safety Modernization Act. This was -- now been signed into law, and it's widely recognized. There are more improvements that we made in our food safety system. This law, for example, would strengthen the safety over fruits and vegetable production, which is exactly where the E. coli outbreak is occurring.

REHM

10:37:22
But it has not been funded.

ORDEN

10:37:24
So -- it has not been funded, and this is a serious concern. Now, maybe this crisis in Europe will remind us once again that we need a strong system here in the United States.

REHM

10:37:34
David Orden, he is professor at Virginia Tech. We all take just a short break here. When we come back, we'll open the phones.

REHM

10:40:02
And we've had numerous emails from people wanting to know how one can make raw vegetables safe. Does cooking the vegetables kill the E. coli, Jeff?

BENEDICT

10:40:19
You know, the evidence on cooking meat is pretty clear and straightforward. I'm not as much of an expert on cooking raw vegetables and to what degree you have to do it. But here is something that was interesting to me, Diane, while I was working on "Poisoned" is I interviewed a physician in Utah who's probably the leading expert on this part of the problem.

BENEDICT

10:40:41
He said to me -- he goes, when Jack in the Box happened -- he said, what used to kill me is I'd go into a restaurant with my wife, and she'd order a hamburger. And we'd order it, you know, medium. She'd order it medium, and it would come back and the juices would run clear. And people have this misconception that if the juices run clear in meat, it's cooked. He said, but if it's processed meat that's been frozen, he said, that doesn't mean anything.

BENEDICT

10:41:02
It doesn't mean anything. And so even if you've cooked your burger on a grill and the juices run clear, that doesn't mean you've cooked it sufficiently. If you're going to eat hamburger, don't mess around. Cook it well done. And, you know, unless you're going to know that it's 155 degrees -- but how many people in barbecue season, which we're going into now, are standing around with a thermometer, popping it in their hamburger?

REHM

10:41:22
And how can you do that regarding vegetables? I mean, you can broil tomatoes, but...

HARRIS

10:41:29
Right. Well, this is one of the -- as one of these experts said to me last week, Gardiner, I know how to make a hamburger safe. I don't know how to make a head of lettuce safe.

REHM

10:41:38
Exactly.

HARRIS

10:41:39
And that is precisely why we're so at the mercy of the food safety system and of, you know, the manufacturers, the growers, the grocers. It has to be safe, and it has to be inspected to be safe.

REHM

10:41:55
All right.

HARRIS

10:41:56
And that's why, you know, this political process is so important. And, right now, there's a rule that's being held up at OMB, the Office of Management and Budget -- this is not the Republicans. This is the Obama administration -- to make six more of this toxic E. coli as an adulterant, and it's been sitting there since January. The Obama administration sort of refuses to say when they're going to come out with this...

REHM

10:42:20
Why? Is it going to cost more money?

HARRIS

10:42:22
It is going to cost more money.

REHM

10:42:23
Yeah.

HARRIS

10:42:24
And there's a fair number of people in the industry who do not want it to come out.

REHM

10:42:27
And you've talked about the fact that those who don't want the FDA doing more extensive -- or don't want it because of small business?

BENEDICT

10:42:39
Well, in fact, it's a curious thing. There's two issues. One, what cost will it impose on the food system overall? And there are, you know, some concerns about those costs. But we spend less than one-tenth of 1 percent of the value of our food production, food consumption on government efforts to keep the food system safe, $700 million budget of FDA, for example.

HARRIS

10:43:01
And again, this is both a Republican and a Democratic issue, Diane...

BENEDICT

10:43:05
Yeah.

HARRIS

10:43:06
...because the small farm lobby was really the biggest group that was against this new food safety modernization act.

REHM

10:43:13
And it's the small farm...

ORDEN

10:43:15
And this is....

HARRIS

10:43:16
Both Republicans and Democrats.

ORDEN

10:43:18
This is a real irony because if E. coli gets onto lettuce because the cow walks across the lettuce field, that is more likely to happen on the smaller, more informal operation...

REHM

10:43:26
All right.

ORDEN

10:43:27
...than in the commercialized, systematic operation.

REHM

10:43:29
All right. To Syracuse, N.Y., good morning, Philip.

PHILIP

10:43:35
Yes, hello. Okay. Let's get straight to the subject here, where this deadly E. coli comes from. You've been dancing around the subject. It comes from our society's deal with the devil, which is factory farms. We feed corn to cattle instead of grass, which they normally eat. This changes their gut so that the E. coli in their guts could survive in our guts. So the ultimate source is our society's desire for cheap food, factory farms where we feed these cattle unnatural diets.

PHILIP

10:44:10
To actually get to the root of where -- how to stop this E. coli, our society would have to change how they raise cattle.

REHM

10:44:22
All right.

HARRIS

10:44:24
You know, that's been around for a long time, this idea. And I'll be the first to say that I'm a big proponent of grass-fed cattle, and I'm not a fan of factory farms. But to simply state across the board that, if all cows were fed grass, E. coli would go away is not true. There are documented cases in the United States of grass-fed cattle who produced E. coli poisoning that people have eaten.

HARRIS

10:44:47
And so, look, they're not the majority of the cases. They're the minority. But, Diane, it's dangerous to simply say, all we have to do is this, and the problem goes away. Not true.

REHM

10:44:56
Right.

BENEDICT

10:44:57
And there's some evidence that free-range chickens are actually more likely to have E. coli in them than these, you know, caged chickens. So there are not simple answers here, Diane.

REHM

10:45:07
All right. Rochester, N.Y., good morning, Elizabeth.

ELIZABETH

10:45:13
Yes. I had a question, a clarification on the antibiotics issue. I had read that the -- what tipped people into HUS when they're exposed to these deadly forms of E. coli is that they receive antibiotics. And then that's what tips them into HUS. Is it possible for someone to get HUS if they have not been exposed to antibiotics?

BENEDICT

10:45:35
Absolutely.

HARRIS

10:45:35
Absolutely, yeah. It's not the antibiotics. I mean antibiotics -- again, we sort of talked about this. I mean, nobody's really sure if antibiotics, you know, there is the theory that if you take antibiotics, it will kill the bacteria in your gut and release a bolus of poison. That might be true or it might not. I mean, by the time you usually get to the bloody diarrhea stage, the infection is well along its way.

HARRIS

10:46:04
But what is known is that taking antibiotics does not help and probably hurts.

REHM

10:46:11
To Cleveland, Ohio, Anthony, you're on the air. Anthony, are you there? Well, his question, which I find interesting, he was concerned about the use of manure in his garden. Any comments, Jeff?

BENEDICT

10:46:33
Well, we have a big garden at our place. And, I think, one thing I want to make sure we don't do here, Diane, is that we don't kind of come down too hard on the small farms because I think that the -- these big outbreaks that we're talking about are rarely traced to small farms because small farms don't have big distribution.

HARRIS

10:46:52
Right.

BENEDICT

10:46:52
And so when a small farm is responsible for a pathogen, it's usually detected pretty quick, and it's containable. It's the industrial farms that usually produce the big outbreaks, and Jack in the Box is an example of that. It was a -- it came from an industrial farm. It was a huge reach. We don't know the source in Germany yet. Nobody really has been able to pinpoint that.

BENEDICT

10:47:12
But I think the benefit of buying local -- I mean, something that Michael Pollan has talked about for years, the benefit of that is, normally, you know your farmer, you know their practices, and it's easy to trace and figure out. And when they do make a mistake, it doesn't go all over the United States.

HARRIS

10:47:28
Yeah, but that doesn't help you when you get sick from the local farmer.

REHM

10:47:31
That's true.

BENEDICT

10:47:32
No, it doesn't.

ORDEN

10:47:33
And it's difficult with just local farms to feed, you know, a trillion-dollar food economy.

BENEDICT

10:47:38
And the issue with manure, by the way, Diane, is that, obviously, manure does have E. coli in it. But that's why you have to have sort of proper composting techniques. There is some controversy in the food safety community about the use of manure and whether the composting techniques are adequate because, of course, you know, when you do composting and you do it adequately, it heats the manure, it kills the E. coli.

BENEDICT

10:48:01
But there are examples of where the composting is not done appropriately. There are pockets of E. coli that survive and then actually spread once the temperatures are down.

REHM

10:48:12
How far back can we trace E. coli outbreaks? Do we know?

HARRIS

10:48:20
I mean, since the dawn of time.

REHM

10:48:22
Well, that's what I want to know. And because, of course, we have all this communication now, we know people get sick and die. Have they always gotten sick and died from E. coli?

HARRIS

10:48:35
Absolutely. Well -- and this was the point that I was making earlier. You know, when you get sick, when you get diarrhea, you don't go to the doctor all that much. You know, it's a terrible case. You'll go to the doctor. In some, you know, your doctor -- in the United States, you know, the share of physicians who actually take a stool sample from you when you go -- I mean, when was the last time you got a stool sample taken when you went to the doctor? Doesn't happen all the time.

REHM

10:48:57
Probably more often with my dog than with me.

HARRIS

10:49:00
Right. Exactly.

BENEDICT

10:49:02
Diane, there is a great moment in the Jack in the Box story where the lawyer, Bill Marler, who brings the lawsuit against Jack in the Box. When kids first started getting sick, Marler goes to the medical library at the University of Washington. He doesn't know anything. And he goes into the library and he -- she says, you're here 'cause of the outbreak. He asks, what do you have on E. coli? And she gives him some literature to look at.

BENEDICT

10:49:24
And the amazing thing was -- this was 1993 -- he could read it all in a day. There were not a lot of studies at that time where they had taken documented cases and done clinical studies to show us. And so, yeah, E. coli has been around for a long time. But in terms of doing clinical research and producing studies on it, it's relatively new.

REHM

10:49:44
Here's an email from Bob in Warwick, RI., who says, "What can the farmer do to preclude dangerous E. coli from his crops? What tools are available to him or her to detect the presence of the bacteria?"

BENEDICT

10:50:06
Well, you know, simple things. Obviously, we know today that we weren't paying as much attention to, here in the U.S. 20 years ago, is the danger of having animals, particularly cows, in close proximity to produce fields. That was done a lot more commonly in the U.S., and even in the '90s, than it is now. Because one simple thing, Diane, is just the -- when cows go to the bathroom and that gets into a water stream that filtrates into produce fields, you have problems.

BENEDICT

10:50:38
We've done simple things like separation that in some countries that's still not done. But when you're talking about small farms, if you've got cattle and you're producing lettuce, you know...

REHM

10:50:49
We've got lots of emails from people still wanting to know what they can do to help make the salads and other raw veggies they prepare at home more safe. Should they soak in bleach and water? I've heard that soaking in bleach is not so good.

HARRIS

10:51:12
No. You don't want to do that. I mean, you know, the only thing you can do, obviously -- I mean, you should obviously wash your vegetables. I mean, that's...

REHM

10:51:20
What about the packaged lettuces that come now? That's...

BENEDICT

10:51:25
Leafy greens?

REHM

10:51:26
Yeah.

BENEDICT

10:51:27
I'll tell you this. When I did -- when I interviewed Bill Marler for "Poisoned," I asked him, what are the five things you never eat? And one of the things that's on the top of his never-eat-fives is pre-packaged leafy greens. He said...

REHM

10:51:41
Because?

BENEDICT

10:51:42
...I just don't do it because it's similar to ground beef if you think about how it's produced. When -- and I don't think people should be afraid to go to the store and buy lettuce and carrots or garden and grow the stuff and eat it. We don't need to be paranoid about this stuff. It's a lot safer, Diane. You just -- you drastically reduce risks if you do simple things, like -- and not everybody can do this, but farmers' markets are a great place to buy food.

BENEDICT

10:52:07
And I'm not saying you can never get sick buying something in a farmers' market. But you go a long ways when you can look the farmer in the eye -- farmers are proud of how they produce their food. They want you to know what they do. And, you know, if you get sick eating something that they made, they're done as farmers, you know, in those kinds of markets. And there's a lot to be said for trying to grow your own and trying to buy food that's produced within 20 miles of your house.

ORDEN

10:52:31
But again, Diane, we have to be realistic. I mean, these are great ideas. I have a big garden as well, but we cannot feed the American urban population with urban gardening or local farmers' markets. So we have to have systems that keep the overall large parts of our food supply safe. The phrase that goes under and this new law would have strengthened, especially for fruits and vegetable production, is HACCP, the hazard analysis and critical control points.

ORDEN

10:52:56
That's setting up a system in the management of your production or processing or marketing chain where you identify points in which contaminates could enter the system. You make advanced plans for how to control those. You monitor for where -- so this HACCP system has spread throughout the food system. This new law would have spread it even further into fruit and vegetable production.

REHM

10:53:16
But...

ORDEN

10:53:18
But it takes some resources to implement that well. That's for sure.

HARRIS

10:53:21
And what's frustrating, Diane, is if you look at the polling, you know, it is off the charts for safe food. People want the government involved, even conservatives, liberals, everybody.

REHM

10:53:32
Gardiner Harris of The New York Times. And you're listening to "The Diane Rehm Show." Let's go to Flint, Mich. Good morning, Tommy. You're on the air.

TOMMY

10:53:44
Yes, my question is, why don't they just use ionizing irradiation to kill the E. coli in the beef? One guy just said that he can't clean up lettuce. Well, they can use ionizing irradiation to clean up the lettuce. I saw it done on PBS myself.

BENEDICT

10:54:00
I'm not a big fan of irradiating food. I mean, I just, you know, we've turned food into such a technical process that it -- these are things that don't need to be done in my book, Diane. It's just, to me, that it's sort of like guys who say, well, why don't you just put a tad of ammonia in ground beef? It kills E. coli, and it's safe. Well, it's safe. But is it healthy? I mean, and there's a difference. And I just think it's not healthy. It's not necessary.

REHM

10:54:25
David, do you want to weigh in?

ORDEN

10:54:27
Irradiation is something the American public has not yet been willing to accept, and may never be willing to accept. I'm not expert on the science of it, but that's certainly the case in terms of the stance that it will kill various, you know, E. coli and...

REHM

10:54:41
But it could do something else we don't know about.

ORDEN

10:54:44
But let's not forget that our generation learned -- we should play in the dirt. You know what I mean? We should play in the dirt, so we build up some natural immunity. And there's a little wisdom in that old wise tale.

HARRIS

10:54:53
Yeah, there's no natural immunity to Shiga toxin-producing E. coli. And, you know, irradiation does work, Diane. I mean, it does. And we're just not -- it is a non-starter, really, in the food safety area because people don't want it.

REHM

10:55:08
All right. To Utica, N. Y., and finally to Jessie. Good morning. You're on the air.

JESSIE

10:55:14
Good morning, Diane. Hi. I'm listening to you on my way to a restaurant specialist. And, I guess, what I want to do is, you know, I do restaurant inspections. But the biggest thing with all this is, you know, proper heating, you know, cooling, reheating, holding all the temperatures, eliminating their hand contact is huge. And we can't stress this enough. You know, I think that, you know, just -- people take it for granted and don't really, you know, think too much of it.

JESSIE

10:55:44
But, I mean, you can eliminate a lot of this just by, you know, the proper holding temperatures and proper cooking and, you know, hand washing and, you know, bare hand contact on cooked and prepared foods.

REHM

10:55:58
But it still happens.

HARRIS

10:56:00
I was at a barbecue -- this is a little -- it's a few months ago. It was an older couple who has been in my family forever, and the father was doing the barbecue. He brought the plates with, you know, the -- sort of the bloody meat, put it on the barbecue. And then as soon as it was off, done cooking, he put it right back on the same plate. And I said, can we get another plate? And he's, no, you want it in the juices, Gardiner.

HARRIS

10:56:24
And I just, you know, and I went ahead 'cause I love these people and ate that meat. And it was a -- but it was tough, Diane. And, I mean, this...

BENEDICT

10:56:34
I would not have done that.

REHM

10:56:36
You would not have done that.

BENEDICT

10:56:37
I would not have done that, I'm telling you.

REHM

10:56:39
Well, the extreme message here is be careful, be thoughtful, be clean about your hands and about counters, about the foods you eat and how you cook it. Thank you all so much. Gardiner Harris of The New York Times, David Orden of Virginia Tech, Jeff Benedict, he's author of "Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat." Thank you all so much. Thanks for listening. I'm Diane Rehm.

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10:57:18
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