The food safety bill and the long cost of foodborne illness

In a nailbiter ending tonight, the US House of Representatives passed the long-stalled, almost-lost, back-from-the-dead FDA Food Safety Modernization Act, a decades-overdue piece of legislation that will equip the US Food and Drug Administration with enforcement tools to help it prevent and track foodborne illness outbreaks.

For people who don’t know the regulatory landscape of food in the United States, it comes as a shock that FDA (which regulates both drugs used in food production and much of the food produced in the US, except for meat and poultry which are under USDA) has so little power. Until now, the FDA could not compel a food recall; it could only ask for a problematic or dangerous food to be recalled, and the food producer could demur. That was, if the FDA even associated a particular food with a foodborne outbreak, which was unlikely given its lack of surveillance resources or inspectors. (A remarkable number of foodborne outbreaks are solved not by the feds but by the Minnesota Department of Public Health, which is well-funded by the state it represents.) The last time food-safety legislation was updated in the US was 1938.

This hard-fought bill — passed several times each by House and Senate, almost done in by objections over its perceived impact on small farmers and producers, and then almost done in again by a procedural error — confers recall and subpoena authority, increases the corps of federal inspectors, installs food tracking systems, and requires big producers to predict and protect against possible contamination and illness by developing detailed written hazard plans. (The best coverage of the bill, by far, was online, at Food Safety News and Grist — go there for more details.)

This bill was a critical advance because, as new numbers from the Centers for Disease Control and Prevention last week made clear, the toll of foodborne illness in the US is massive: every year, there are 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths. Out of that 48 million, 38 million are never explained because the causative agent was not identified or investigators could not gather enough data. Because of those data gaps, as premier food-safety attorney Bill Marler reminded in a post during the run-up to the food-safety vote, the US food supply is strikingly vulnerable to bioterrorism. After the anthrax-letter attacks, in fact, an FDA report said “there is a high likelihood, over the course of a year, that a significant number of people will be affected by an act of food terrorism” — which would be likely to look like a foodborne outbreak, and which before today the FDA would have had limited resources to investigate or prevent. So for both those reasons — true foodborne illness, and bioterrorism masquerading as it — this legislation, while not everything that advocates wanted, was sorely needed.

When we think of foodborne illness, we tend to think of the high-profile cases, the deaths and life-changing illnesses that occur to people who had the misfortune to eat the wrong cheese or burger or leaf of salad. Both Marler and the nonprofit group Safe Tables Our Priority, founded by family members of victims, have done hard work over years to bring the tragic stories of these completely avoidable illnesses into the public eye. But there’s an additional cadre of victims of foodborne illness whose stories often go untold in the food-safety debate. Their experience contains less immediate poignance, perhaps, but just as much public health importance, and with the bill passed, it’s a good time to consider them.

To do that, we have to visit a town called Walkerton.

I went to Walkerton in May 2000. It’s a small town, pretty, rural, way west of Toronto on the way to Lake Huron. It’s in the midst of Ontario’s cattle country, which is key to what happened there: Thanks to extraordinary rains that spring, creating extraordinary amounts of runoff, cattle manure and the bacteria it was carrying washed into the town’s under-chlorinated water source. Among the bacteria was E. coli O157:H7. By the time I arrived (here’s my long-ago story), 1,000 people — one-fifth of the town’s population — had been sickened by the highly pathogenic bug. completely overwhelming the local medical system, such as it was. Five had died. The ultimate toll was seven deaths and 2,300 cases, almost half the town.

Walkerton was a public health tragedy, but in a country with a guarantee of health care, it was also a scandal — enough of a scandal that it triggered the Walkerton Health Study, a seven-year retrospective followup, and further studies beyond that. One has just been published in the British Medical Journal. The thoroughness of its analysis makes the true burden of foodborne illness — not just the acute illnesses, but the long-term health burden and extraordinary health care costs — very clear.

There were 1,977 Walkerton Health Study participants in the BMJ study, 54 percent of whom were ill during the Walkerton outbreak. By 2008, those who had been sick were:

  • 1.3 times more likely to have high blood pressure
  • 2.1 times more likely to have heart disease
  • 3.4 times more likely to have damaged kidneys.

Those results make it so likely that the Walkerton victims will develop heart disease or kidney disease later in life that the authors (from the University of Western Ontario) recommend they undergo annual blood-pressure and kidney-function screening for the rest of their lives.

As a result of drinking their own tap water.

Foodborne illness survivors have said for years that they experience long-term after-effects from their illnesses, but until now those reports were only single data points. This is the first study of its kind. Its results underline how critical the food-safety vote today really was. Improved attention to and funding for foodborne illness won’t only reduce deaths and acute illnesses — it should also reduce the kind of long-term illness, and the costs of caring for them, that the Walkerton victims incurred.

(H/t Dr. Eli Perencevich and Controversies in HAI Prevention for calling out the Walkerton study.)

Cite: Clark WF et al. Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study. BMJ 17 Nov 2010. doi: 10.1136/bmj.c6020

Image via Flickr user JasonEppink under CC


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