This article first appeared in the St. Louis Beacon, Nov. 7, 2011 - Missourians have probably worried more about E. coli turning up in their lakes than their lettuce.
That attitude probably changed recently when the state Department of Health and Senior Services reported that a deadly form of the bug -- known as E. coli O157 -- had invaded parts of the local food chain. As of Monday morning, 28 cases had been confirmed in St. Louis County, up from 24 on Friday.
State officials have tested 55 food samples, but have yet to identify the source of the outbreak. Investigators first focused on salad bars at some Schnucks stores, where some of the victims had eaten, but none of the food products from them has tested positive for the bacteria. Federal investigators are also looking beyond Missouri because some food items that might have sickened people were imported from outside the state.
While the outbreak remains a worry for health officials, some stepped back to look at the big picture and noted that E. coli outbreaks had been declining in Missouri in recent years. Health officials recorded 68 cases in 2009, the most recent data available. That number represented 10.5 percent fewer cases than in 2008. The drop marked the third year the number had declined.
The recent outbreak in St. Louis County appears to be a milder form of a national problem posed by food-borne contaminants. The Centers for Disease Control and Prevention reports that the bacteria sickens 48 million Americans -- 1 in every 6 -- each year. Of that number, 128,000 require hospitalization, and 3,000 die.
These statistics were among reasons Congress voted last year to enact the Food Safety Modernization Act, the most far-reaching law to protect the food chain in 70 years. The price tag was $1.4 billion, with most of the funding for boosting the Food and Drug Administration's regulatory power.
"Every food processor will now have to have a plan in place to help enhance safety," says Michael Doyle, a food microbiologist at the University of Georgia's Center for Food Safety. "Congress has now mandated that FDA establishes rules -- not just guidelines but rules -- for agricultural practices for producing fresh produce."
In effect, the new law is supposed to help the FDA and the industry take active steps to prevent contamination. The FDA has jurisdiction over all food, except meat, poultry and dairy. Inspections of these are handled by the Department of Agriculture.
Food safety fight moves to Congress
While the contamination-prevention plan sounds like a powerful tool, debate about its worth and costs is far from over. The fight over the act's future has shifted to how much or little Congress will spend to help the FDA carry out the mandate. These issues worry Sen. Dick Durbin, D-Ill. During a visit to the Metro East on Friday, he called attention to the difference in FDA and U.S. Department of Agriculture inspections as he remembered the days when he worked at Hunter Packing Company in East St. Louis to pay for college.
"The U.S. Department of Agriculture had an inspector on the spot every minute of every day that plant was open," he said. "That was expected. That was a meat plant. And we were dealing with pork products. But when it comes to the Food and Drug Administration, they're fortunate to get in and visit their facilities once every 12 months. Not every day -- once every 12 months. So we need to put more produce inspectors and food inspectors throughout the FDA as well."
Yet Durbin points to a "dramatic" cutback in FDA funding and adds that it's "cold comfort for people to know that we have a good law on the books if we don't have the people to make it work."
The FDA's budget already has been cut by at least $87 million this year; many House Republicans seem unwilling to spend more, particularly to increase inspections. Their concerns range from the federal deficit to the potentially adverse impact more regulations could have on food prices.
"I will just tell you we are in a budget situation where we can't spend as much as we want," Durbin said, adding public health and safety must "be our highest priority."
He and fellow Democratic Sen. Claire McCaskill of Missouri are among lawmakers who voted for the act. Missouri Sen. Roy Blunt, a Republican, said through a spokesperson that he couldn't support it.
"Sen. Blunt understands that a safe food supply is vital for our families and communities, which is why he supports efforts to improve our nation's food safety system," said spokeswoman Amber Marchand. "However, he also understands that federal regulations should be science-based -- especially during a time when job creators are looking for more certainty as they consider hiring more people."
She added that Blunt felt "this sweeping legislation" would not only result in expanded authority for FDA regulators but would authorize the agency to "regulate agricultural production practices." While opposing the food act, Blunt did vote last week for final passage of the agriculture appropriations bill "and he supports the level of funding included in this legislation for the FDA," Marachand says.
Durbin hopes a conference panel will bridge the gap between House and Senate differences over the FDA's funding, particularly on the issue of underwriting more inspections. He'd prefer that they not only occurred more frequently but started right away.
"I'd like to do it all at once," Durbin said but added that, "we have to really phase it in." He feels so strongly about the issue that he had favored a "user fee" in food processing to "increase inspections dramatically more than this bill did."
Durbin is disappointed that Congress apparently isn't going to start phasing in inspections at all during the first year of the law -- despite the fact that legislation says that the frequency of inspections would increase beginning from the date the law took effect.
"Unfortunately, it's going to be a cutback in inspectors if we don't have a conference that agrees to restore the funds," Durbin says.
Consumer groups support new law
Even so, some consumer groups are elated by what they see as sweeping changes in food laws and the FDA's new authority to address problems related to food-borne illnesses.
Down the road, the law might head off E. coli outbreaks like the one in the St. Louis area, predicts Sarah Klein, food safety attorney at the Center for Science in the Public Interest in Washington. Her group was among those that had urged Blunt and some other Senate leaders this summer to press the House to rethink a continuing resolution to give the FDA millions less than it got during the last fiscal year. The group had argued that the reduction would lead to fewer FDA inspections of food facilities, among other duties.
"But overall, we are very happy with the law," Klein says. "We are now working to make sure the FDA has the budget to fulfill its new mandate. In the past, it didn't really do anything until there was a problem. It was much more reactive. This bill will put the FDA in a much more preventive posture."
One question growing out of the E. coli outbreaks in Missouri and elsewhere is how much protection does hand washing offer against picking up or spreading food borne illnesses?
"We certainly don't want to scare people away from eating healthy foods or produce," says Klein. "Obviously, hand washing is very important for retail workers, whether they are in restaurants or grocery stores. We also advise consumers to rinse produce before eating it."
But she adds that asking consumers to take the lead in removing contaminants is like asking someone to scrub out a stubborn stain on a piece of clothing.
"The stain is embedded so deeply that even the dry cleaner can't remove it. In the same way, sometimes the contamination is in the soil and comes up through the roots into plants, like the E. coli outbreak in spinach in 2007. The E. coli was inside the lettuce. Or it might be in processed food like peanut butter. There's nothing a consumer can do to remove it."
For that reason, she says, more policing of and by food processors is the key to preventing outbreaks.
Just as consumer groups have praised the law, other groups have derided it as a costly regulation that would harm small businesses. But some of that criticism has eased due to provisions to exempt certain small producers. These include those who might sell to farmers markets and food co-ops, for example. Businesses with annual sales of less than $500,000 are exempted from the tougher provisions, including the unprecedented requirement for companies to develop written plans for evaluating the potential for contaminants and other hazards in processing and manufacturing food.
Klein concedes some consumer and public interest groups may have had questions about certain small-business exemptions, but she says most are pleased by the way much larger issues were handled. These include the law's provision requiring food importers to show proof that their suppliers have verified the safety of their products. That's important, Klein and others say, because about 60 percent of fresh fruits and vegetables and 80 percent of the seafood consumed in this country are imported.
New technology for food safety
Over the years, researchers have proposed other potential ways to kill contaminants. Irradiation used to be mentioned.
"But people fear that you might glow in the dark after you eat" irradiated food, says Doyle the food microbiologist at the University of Georgia.
"People don't want irradiated food. That's part of the problem. That experiment has been done. There was a company that had all kinds of units throughout the country to irradiate beef, but they couldn't sell the idea because people didn't want to buy it. I don't know if that's the answer, especially for produce."
Klein agrees, adding that one legitimate concern is that irradiation changes both the texture and taste of lettuce. She and Doyle add that the contamination often occurs long before the food reaches consumers.
"You have to start in the fields, where fruits and vegetables are grown," Doyle says. "That's where the safety has to start, with treatment along the way to reduce the risk."
But starting in the fields, Klein says, doesn't mean pointing fingers only at farm workers.
"When you see E. coli on a farm in a produce item, if you follow that far enough, you are going to end up at a cow on the farm walking around in the lettuce," she says. "Or you are going to find water either contaminated nearby in a cattle ranch or there was a wild pig that ran through the cattle ranch, then ran through the lettuce."
Those problems explain why some have suggested that E. coli is best attacked through vaccines for livestock. That subject touched off a lively international debate this summer between European and Western E. coli experts, including Dr. Phillip Tarr, when it appeared that antibiotics were being suggested after E. coli sickened about 1,500 people in Germany.
Tarr, a professor of pediatrics at Washington University, told the New York Times: "If you give antibiotics and the strain is resistant, then you give that bacteria a competitive advantage to the other bugs in your gut that are susceptible to the drugs, and so it's an even better environment for the infection."
Following the outbreak in St. Louis, he urged patience, noting the challenge of investigators finding the source.
"It's a reasonably large outbreak," he told the Beacon. "It really takes some time to figure out" the source.
Klein added her own concern about vaccines. She's afraid it would give some producers an excuse to avoid other step to keep their production systems and products free of pathogens.
"There is no silver bullet," Klein says. "It's a matter of creating robust food safety plans and a government agency with adequate funding and a mandate to do the oversight. Obviously, the industry needs to make sure the food isn't contaminated in the first place."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
Jason Rosenbaum, a freelance journalist in St. Louis, covers government and politics.