Is foodborne illness from fresh produce a real problem?
Is foodborne illness from fresh produce a real problem?
Early in November, the Food & Drug Administration sent a warning letter to lettuce producers in the Salinas Valley expressing concern over foodborne illnesses and outbreaks associated with lettuce.
Since the FDA letter, there has been an article in The Wall Street Journal titled "When Eating Your Vegetables Makes You Sick." And an article in The Los Angeles Times in late November quoted a Los Angeles County Department of Health official as saying that lettuce was the likely culprit in a number of Hepatitis A outbreaks in his county.
While he could not identify the actual lettuce involved, he opined to this reporter that it probably was due to some problem during production such as contaminated water. He advised consumers to wash their produce before eating it and to make sure their restaurant operators are doing the same thing.
Since the FDA letter was released, the executives from many produce industry organizations have been meeting diligently to identify and solve this lettuce problem. In fact, on Friday, Dec. 2, there was a conference call with dozens of participants discussing where the lettuce industry is and what can be done to avoid future problems.
The FDA has spoken and the industry is going to solve the problem. There apparently has been little discussion, privately or publicly, about whether there truly is a problem. One produce industry association executive told this reporter that getting in a battle with the FDA is a no-win proposition. If the FDA believes there is a problem, there is one. The executive said, "If we question whether there is an issue, they may make it their business to find one."
The fresh produce industry is taking the position that one outbreak or one illness is one too many. If there is a way to stop these illness problems, then everything should be done to take those steps.
No one would argue with that.
But it is a legitimate discussion to put the scope of this problem in context and to determine if the public discussion is creating a bigger problem than it is solving. Does the public discussion, for example, reduce the consumption of fresh fruits and vegetables?
Robert Tauxe, chief of the foodborne illness division of the Centers for Disease Control, who provided the statistics that formed the background for The Wall Street Journal story, said that in no way should people stop eating vegetables. Jonathan Fielding, the Los Angeles health official who was quoted in the Los Angeles Times, also said that no one should eat less lettuce because of his declaration.
Of course, there are no statistics that can quantify the actual effects of these and other stories tying fruits and vegetables to illness. Maybe such stories have become so common that the public no longer reacts. But it is hard to believe that there is not somebody somewhere who did give up lettuce or cut down on his or her consumption because of the FDA's action and the reporting of such.
Even worse, according to experts, is that some people might be taking the advice of Dr. Fielding and are re-washing the vegetables that have already been washed. Dr. Fielding thinks that is a good idea. A produce industry expert said that washing fruits and vegetables that have already been washed will probably lead to more contamination than it will solve. "Each time the product is handled is an additional potential risk factor. We want to cut down on handling."
Consequently, this official opined that the chances that the restaurant worker will contaminate the product by touching it with his own hands when washing is greater than his chance of washing off contamination.
That is especially true if you believe Dr. Tauxe of the CDC. "It is very difficult to wash off contamination," he said. "When we have purposely contaminated produce in the laboratory, we have found that it is not easy to get rid of that contamination through washing."
In fact, he said that he would not recommend that people wash produce that has already been washed. "I do not have enough information to make a recommendation."
Of course, he said that it is common sense to clean dirt and other debris off produce before eating it, but beyond that, he could not say how helpful washing truly is.
The CDC does know how often consumers get sick from eating fruits and vegetables - or at least it knows how many outbreaks and illnesses it has tied to fresh fruits and vegetables. The report quoted by The Wall Street Journal and published by the CDC found 190 produce-associated outbreaks in the 25-year period covering 1973 to 1997. Those outbreaks resulted in 16,058 illnesses, 598 hospitalizations and eight deaths. The frequency in connection increased throughout the years. In the 1970s, the CDC tied two outbreaks per year with fresh produce, and by the 1990s, there were about 16 produce-related illness outbreaks per year.
Updating those numbers but speaking only of lettuce, in the November FDA letter to the lettuce industry, that agency noted that there have been 18 lettuce-related outbreaks (including one involving spinach) in the past decade leading to 409 illnesses and two deaths.
Certainly any illness and, of course, any death is one two many. But what does being "one too many" mean? Is it one too many if that means eliminating the consumption of fruits and vegetables? Is it possible to completely wipe out all illnesses and all deaths? After all, this is a raw product with no "kill step" for pathogens, as Dr. Tauxe called it. For virtually all other foodborne illnesses, such as those caused by meat or poultry, the ability to "kill" the illness-causing pathogen lies with the preparer of that food. These pathogens die when exposed to the extreme heat of cooking.
One produce industry association executive told this reporter that the FDA could have no illness and no outbreaks if it just requires lettuce to be cooked to 170 degrees before it is served. Of course, that was said with tongue firmly planted in cheek.
Both Drs. Tauxe and Fielding obviously believe the benefits of eating produce far outweigh the risk. So what is the risk in real numbers?
Conservatively speaking, there are 1 billion servings of fruits and vegetables consumed per day in the United States. That equals 365 billion servings per year. Using the CDC numbers in the group's paper reveals that in the 1990s, there was an average of 688 produce-related illnesses each year and a death about every three years. So the chance of getting ill and having it tracked by the CDC during any one serving of produce is about one in 530 million. The chance of dying from that single serving is about one in 1 trillion.
Compare that to other statistics put out by the CDC. In 2002, a random name pulled out of a list of all Americans had a one in 1,755 chance of dying from an external cause, which does not include disease. In that year, 164,112 died in this manner. That year an individual had about a one in 6,000 chance of dying from an accident involving a vehicle and one in 5,000 chance of dying in an accident not involving a vehicle. In 2002, almost 1,600 people died after falling from stairs or steps. That equated to one out of every 180,000 people. The proverbial struck by lightning claimed 66 lives, a chance of one in 4.4 million.
Forty people in 2002 died from contact with hot tap water. So your chances are about 125 times greater of dying from hot tap water than from eating fruits and vegetables. In the past 10 years, about 200 times more people have died from exposure to hot tap water than from eating lettuce. On the other hand, heart disease kills almost 1 million people in the United States each year, which accounts for about 39 percent of all deaths. Cancers take another 550,000 lives, or 23 percent of all U.S. deaths. There is a growing body of evidence that the consumption of fruits and vegetables can help reduce those numbers.
So by all means, try to make fruits and vegetables as safe as possible, cutting out contamination whenever you can. But do not lose sight of the big picture.
Since the FDA letter, there has been an article in The Wall Street Journal titled "When Eating Your Vegetables Makes You Sick." And an article in The Los Angeles Times in late November quoted a Los Angeles County Department of Health official as saying that lettuce was the likely culprit in a number of Hepatitis A outbreaks in his county.
While he could not identify the actual lettuce involved, he opined to this reporter that it probably was due to some problem during production such as contaminated water. He advised consumers to wash their produce before eating it and to make sure their restaurant operators are doing the same thing.
Since the FDA letter was released, the executives from many produce industry organizations have been meeting diligently to identify and solve this lettuce problem. In fact, on Friday, Dec. 2, there was a conference call with dozens of participants discussing where the lettuce industry is and what can be done to avoid future problems.
The FDA has spoken and the industry is going to solve the problem. There apparently has been little discussion, privately or publicly, about whether there truly is a problem. One produce industry association executive told this reporter that getting in a battle with the FDA is a no-win proposition. If the FDA believes there is a problem, there is one. The executive said, "If we question whether there is an issue, they may make it their business to find one."
The fresh produce industry is taking the position that one outbreak or one illness is one too many. If there is a way to stop these illness problems, then everything should be done to take those steps.
No one would argue with that.
But it is a legitimate discussion to put the scope of this problem in context and to determine if the public discussion is creating a bigger problem than it is solving. Does the public discussion, for example, reduce the consumption of fresh fruits and vegetables?
Robert Tauxe, chief of the foodborne illness division of the Centers for Disease Control, who provided the statistics that formed the background for The Wall Street Journal story, said that in no way should people stop eating vegetables. Jonathan Fielding, the Los Angeles health official who was quoted in the Los Angeles Times, also said that no one should eat less lettuce because of his declaration.
Of course, there are no statistics that can quantify the actual effects of these and other stories tying fruits and vegetables to illness. Maybe such stories have become so common that the public no longer reacts. But it is hard to believe that there is not somebody somewhere who did give up lettuce or cut down on his or her consumption because of the FDA's action and the reporting of such.
Even worse, according to experts, is that some people might be taking the advice of Dr. Fielding and are re-washing the vegetables that have already been washed. Dr. Fielding thinks that is a good idea. A produce industry expert said that washing fruits and vegetables that have already been washed will probably lead to more contamination than it will solve. "Each time the product is handled is an additional potential risk factor. We want to cut down on handling."
Consequently, this official opined that the chances that the restaurant worker will contaminate the product by touching it with his own hands when washing is greater than his chance of washing off contamination.
That is especially true if you believe Dr. Tauxe of the CDC. "It is very difficult to wash off contamination," he said. "When we have purposely contaminated produce in the laboratory, we have found that it is not easy to get rid of that contamination through washing."
In fact, he said that he would not recommend that people wash produce that has already been washed. "I do not have enough information to make a recommendation."
Of course, he said that it is common sense to clean dirt and other debris off produce before eating it, but beyond that, he could not say how helpful washing truly is.
The CDC does know how often consumers get sick from eating fruits and vegetables - or at least it knows how many outbreaks and illnesses it has tied to fresh fruits and vegetables. The report quoted by The Wall Street Journal and published by the CDC found 190 produce-associated outbreaks in the 25-year period covering 1973 to 1997. Those outbreaks resulted in 16,058 illnesses, 598 hospitalizations and eight deaths. The frequency in connection increased throughout the years. In the 1970s, the CDC tied two outbreaks per year with fresh produce, and by the 1990s, there were about 16 produce-related illness outbreaks per year.
Updating those numbers but speaking only of lettuce, in the November FDA letter to the lettuce industry, that agency noted that there have been 18 lettuce-related outbreaks (including one involving spinach) in the past decade leading to 409 illnesses and two deaths.
Certainly any illness and, of course, any death is one two many. But what does being "one too many" mean? Is it one too many if that means eliminating the consumption of fruits and vegetables? Is it possible to completely wipe out all illnesses and all deaths? After all, this is a raw product with no "kill step" for pathogens, as Dr. Tauxe called it. For virtually all other foodborne illnesses, such as those caused by meat or poultry, the ability to "kill" the illness-causing pathogen lies with the preparer of that food. These pathogens die when exposed to the extreme heat of cooking.
One produce industry association executive told this reporter that the FDA could have no illness and no outbreaks if it just requires lettuce to be cooked to 170 degrees before it is served. Of course, that was said with tongue firmly planted in cheek.
Both Drs. Tauxe and Fielding obviously believe the benefits of eating produce far outweigh the risk. So what is the risk in real numbers?
Conservatively speaking, there are 1 billion servings of fruits and vegetables consumed per day in the United States. That equals 365 billion servings per year. Using the CDC numbers in the group's paper reveals that in the 1990s, there was an average of 688 produce-related illnesses each year and a death about every three years. So the chance of getting ill and having it tracked by the CDC during any one serving of produce is about one in 530 million. The chance of dying from that single serving is about one in 1 trillion.
Compare that to other statistics put out by the CDC. In 2002, a random name pulled out of a list of all Americans had a one in 1,755 chance of dying from an external cause, which does not include disease. In that year, 164,112 died in this manner. That year an individual had about a one in 6,000 chance of dying from an accident involving a vehicle and one in 5,000 chance of dying in an accident not involving a vehicle. In 2002, almost 1,600 people died after falling from stairs or steps. That equated to one out of every 180,000 people. The proverbial struck by lightning claimed 66 lives, a chance of one in 4.4 million.
Forty people in 2002 died from contact with hot tap water. So your chances are about 125 times greater of dying from hot tap water than from eating fruits and vegetables. In the past 10 years, about 200 times more people have died from exposure to hot tap water than from eating lettuce. On the other hand, heart disease kills almost 1 million people in the United States each year, which accounts for about 39 percent of all deaths. Cancers take another 550,000 lives, or 23 percent of all U.S. deaths. There is a growing body of evidence that the consumption of fruits and vegetables can help reduce those numbers.
So by all means, try to make fruits and vegetables as safe as possible, cutting out contamination whenever you can. But do not lose sight of the big picture.
