Chapter 7
Safer and Healthier Foods
'/rucks lI'ailill,!! /(l e,ul"
II,e U.S III Ilrl' .\lexi(all
bonia.
Looking Back
All eMly Amai(l!lI 5/0fe, circa /9/0.
[n the past, highly processed foods and beverages were not
the mainstay of the American diet as they are today. An
Amc rican shopping in any supermarket today can choose
to ignore fresh produce. fresh meats and fresh baked goods
and still pllrchase foods rich in nu t rients. T hese foods are
prepackaged, lIsually by the manufacturer. and l:lbe!ed for
their nutrit ional value. These required labels intend to
guide consumers toward healthy choices, reassuring them
that foods are safe. Foods are not without risk in this COUI1-
try, however, despite the best efforts of the United States
Deparrmcllt of Agriculture (USDA), its Food Safety
Inspection Service (FSIS), the United States Food and
Drug Administration (FDA), the Cente rs for Disea~e
Control and Prevention (CDC) and state and local health
deparrmcms. Much of the fresh produce for sale at certain
times of year Comes across our bo rders from M exico, Chile,
Brazil and other countries, where safety standards arc
beyond our control. In 1970, each American ate approxi-
mately 175 pounds of fresh fruits and vegetables a year.
By 1995, that number rose to 220 pounds per person.
Americans also choosc to cat am lllu ch man:: frequemly
than in the past. I3etween 1970 and 2004, the percentage of
food dollars spent away from home increased from 34 per-
cent to 47 perccnt. In additio n , the very young in day-care
cente rs and the very old in nursing homes arc populations
at particular risk for foodbornc illness, and these popula-
tions are growing. Since foodborne illnesses arise most
orten from rresh produce and from restaurants or other
food-se rvi ce purveyors, growing numbers of Americans are
clearly at greater risk for inness . Within the public health
community, improvements in systems that protect food LH"CI! III II
safety are still needed. tlay+wrt' (filler.

It is estimated that there are 76 minion cases of foodborne

illness in the United States per year, resulting in patient-
related COStS in rhe billions of dollars. Ea ch year, foodborne
diseases cau se marc than 300,000 hospitalizations and an
estimated 5,000 deaths. In fact, one of eve ry 100 hospital -
izations and one of every 500 death s in the United States
are thought to result from contamin ated food. .. It is
estimated that from one in three to one in four people will
,
It is estimated
suffer a foodborne illness each year. The full burden may
that from Olle in
never be known, however, since large-sca le studies have yet
three to one in
to be conducted and record- keeping is unreliable. The
four people will
actual llumber of illnesses may be much highe r because
food borne illness is underreported and often misdiagnosed. suffe r a food-
Many people with mild cases do nOt seek medical help. borne illness each
I3ecause symptoms are often nonspecific - nausea, vomiti ng year.
and diarrhea - food poisoning can be mistaken for the flu
or some other com mon ailment. Even when a victim seeks
the help or a physi cia n , many health fa cilities laek th e labo-
ratory technology necessary to identify specific pathogens.

Looking back in history, from tbe tillle of H ippocrates

2,000 yea rs ago to the dawn of modern medicine, little
distinction was madc betwee n food and drugs. Around
460 I3C, Hippocrates recognized the essential relationship
betwcen food and health. H e urged others to study closely
the daily dietary regime n he associated with good health.
TheophrasLls, who lived from 370-285 BC, wrote E" 1I1iry
[,,10 P/<HIIS. the first great botanical treatise that id cntified
plants as so urces of food and medicine. But adulteration
of food with fill ers was noted even in these ancient times.
Cato, w ho lived from 234-149 BC, wrote 011 Agriw/wre, in
 which he recommended "the addition to w in e of boiled-
down must. salt. marble dust and resin" and included a
method to determmc whether wine "has been watered."
Pliny the Elder. the author of !\Iawra/ History. lived fro m
AD 23-79 . Nor surprisingly, after Caro, he found wide-
spread adulteration in the food sup ply, describing bread
as being full of"chalk, vegetable meals :md eve ll cattle
fodder." He also found that pepper waS often adulterated
with juniper berries.

G:den, the renowned Roman physician who lived frolll

AD 131-20 I, followed the philosophical tradition of the
school of H ippocr:Hes. He warned about th e cOlllmon
adulteration of food products, but more important, he
advocated moderation as the principal rule for a sound
diet. Despite all the advances in medical science and lltltri-
tion in the intervening centllrics, no OilC has improved 011
Galen's fundamental rule of sou nd nutrition.

[n Europe during the Middle Ages, the trade guilds regu-

l:lted food prodllCtS. The gUIlds, which d:1ted back to the
time of the Norman Conqu est, cove red every important
food category, including bakers, butche rs, cooks, grocers,
Gall'lI, II R""1II11 fruiters. poulte rs and salters. They had the power to search
pllysirial1,IIIII'IICd/ell premises and seize ullwholesome products, regulating the
I/wdera/ioll 1'" II marketing of food to the public.
soulld dirt.
By the beginning of the 19th century, advances in chem ical
analysis prov ided q ualitative methods to detect many com-
mon food adulreralHS. In 1820, a German-born che mist.
Frederick Accum, working in England. published his land-
l1l:1rk tre:1tise AdllltemlillllS (!{ Food lind C II/illar), P(liSOIlS. The
book was an imlllcdi:m: success. ga inin g widespread public-
ity in newsp.1pers and capturin g the attention of the public.
Acculll may be th e first expert in foo d s:1fety to achieve
hoped-for public education by using th e vehicles of l11a ~s
communication [hat we re then at his dispos.11.

In 1906, the Pure Food and Dnlgs Act ushered in the

modern era of food safety in the United States. Enacted
during the Theodore R oosevel t ldministrltion, the act cre-
ated <I l3ureau of Chemistry, the agency now kn own as the
Food :lIld Drug Administration, to enforce food and drug
laws meant to protect the AmeriC:lI1 people. ThI S act had
first been proposed in 1879 by Peter Collier. chief chemist
at the Dcpartmcnt of Agr icu lture, ;ll1d finally came into
being only after co ncerted pressure by organized medicine,
women's groups, the press and state public health officials.
They were helped in their advocacy by Upton Sinclair's
best-selling novel, ThejuII.f!le , which exposed unsanitary
conditions in the meatpacking industry. ~ The public
became so aroused by those appalling conditions th;lt ne i-
,
The public
ther industry nor its supporters in Congress could prevent
became so
passage of the Pure Food and Drugs Act.
aro used by those
A part of the Department of Agriculture, the Bureau of appalli ng condi-
Chemistry found agricultural f..irs to be a preferred venue tions that neither
for campaigns to educate the public. The chief chemist, industry nor its
Harvey W. Wi ley, M D, considered by many to be the supporters in
founding father of the FDA, tried to separate scicmific facts Congress could
on food safety from scares that were fast becoming a public prevent passage of
focus. After the runaway success of Tile jlmgle, inflamma- t he Pure Food
tory publications fed growing public mistrust, which was and Drugs Act.
further inflamed by congressional hearings. Examples of
food safety issues that inflamed the public we re the widely
used, but unsafe. food preservative bo rax and the many
products bbelt'd "pure" that were in fact counterfeits. Wiley
convened a Poison Squad at the Bureau of Chemistry and
soon borax, salicylic acid, formaldehyde and copper sulfate
were banned as food additives. The operative standard for
each food product became a reasonable certainty that
it caused no harm.

Food fortification began in the United States in 1924

wi t h the introduction of iodized salt in Michigan. Studies
showed that the inc idence of goiter, a swelling of the thy-
roid gland caused by iodine deficiency, declined from 38.6
percent to nine percent; and iodized salt was soon intro-
duced throughout the country, virtually eliminating iodine
deficiency as a serious health chre.:l t by the 1930s. Pe rhaps
'!ODTH M~IV1"SAJn'
the most famous food-fortification case concerns niacin in PURE 'OODA~DDRUII LAWS

breads and ce reals. [n the early 19005, pellagra occurred

to some extent in every state, and mortality statistics indi- CmllllJ('lIJomlil'f SllIlIIp
cated that it was the most seve re nutritional deficiency hOl/oril/.1!. /Jr. I-IIIW('Y W
disease ever recorded III U.S. history. Pellagra presents with Wi/('y (ll/til/u' Pllre
derma titis. diarrhea, inflamed mucous membranes and. in Pood and Dm:~ lallls.
severe cases, dementia. It flares up when the skin is exposed
to strong sunlight, and in many southern states during the
peak incidence years of 1928 and 1929, pellagra became
one of tile leading causes of death. [n 1937, the disease was
 ,
... ,

All iudilllduill willi pellagra.

tied directly to a dietary deficiency in 13 vitamin niacin ,

pr imarily in poor people who lacked ~l.IlilTl:l l food - meat,
eggs, dairy produc ts - ill their diets and subsisted m311l1y
on corn. Bakers began introducing niacin , identified as an
anti-pcllcgr:l agent, into breads and cereals through yeaSt, and
by 1939, the incidence o f pellagra began a rapid decline.
Cu rrent controversies in the American diet , n:ulldy an
overabu ndan ce of sugar, overindulgence in processed foods
and lack of control in portion size. co ntribute to epidemics

, of dental caries, ca rdi ovascubr dise:tse, diabetes and obesity.

~ I-Io.!alth and dental educati o n in schools and homes
can help stem the epidemics, but the real solution comes
H ealth and (i·OIll individual w ill power. TIl/:' Surgeon General issues
dental education per iodic upd:ltes on healthy weights, :l.nd the number of
in sc hools and overweight and obese people keeps rising. c:lusing real
homes call concern in the public health community. H ea lthy foods
help stem th e and portion control arc only put o f the solution. Increased
epidemics, hut physi ca l activity in a society gone seden tary is equally
the real solution important.
co mes from indi-
vidual will power. In the United States, the food safety syste m is b:lsed all
federal an d sta te laws thal arc strong, flexible and SC lence-
based and on industry 's legal responsibility to produce safe
food s. T he development and revision of reglilatio ns occm
in an ope n and transparent process in public, allowing -
and even encouraging - participation by thl' regulated
industry, consume rs and other sta ke holders th roughout the
process. Old agency files at the FDA contain elaborate
studi es co nducted with scient ists from academia and indus-
try that gathered data that even now serve as tbe basis of
regulations. Not until th e late 19705, when consum er inter-
est in th e environment and th e foo d supply began to
increase, did this cooperative relationship end. Since the
1970s, th e FDA has worked essent ially at arm's lengt h from
industry in an ad versa rial environ menr.

Still, the federal gove rnment funds im portant resea rch ce ll -

ters that are based on uni versity camp uses. North Caro lin a
State University, Mi chi gan State University and Rutgers
University each hosts an importam research cente r fo r food
safety and teclmology. Iron icall y, the federal subsidies that
help fund these centers allow the federal government to
stretch its ow n scarce resou rces.

A T imeline of Food Safety Developments in t h e

U.S. Federa l Government, 1879 to the Presen t :

1879 I'c,er Cullier. chief chemi~, at ,he Departmenl of AWicu ltu,,'. sUPI'0rl~ a bill to ",.I.;~ food adulteralion a
fcdc ... 1 crllne: Ihe bill finally become. law in 1'X)6.

1906 Pure Food and Drugs ACl. based on Cull;"rs bill. CTea,eS th~ iJureau of Chel11i,try within th" U.S.
Department of Agri culture.

1906 First Me" 1I'IpcClion Act. allowing "siJ;ht, touch. smcll . insl',·cl ion iu 'bllghl~rhollSes (0 dacet u","nitary
condItions and ~dultcr:llcd prod",,!.

1912 Sherley Amendment to the Pure Food ~nd DrUb'S Act prohibits (311<· and (r~lItlul<-nr claims: althuuJ;h. the
guvernlllcnt h"" 'u pro~e jmcnt '" decelvc, not eas.ly ~chicvcd in the face of so ",allY ··"OSln"" " .. ken··
ex-pressing 6ilh in worthless goods.

1927 Food. Dru g and InsectiCIde Ad"';nIStnIlOIi is crelled from th,· [lure,'u ofCh,·nllSlry.mtrgUlf: 11"·I,,scclicide
o"d Fungicide Iluard.

1930 Th e Fuud and Drug Ad"nnISl",non (FDA) comes in,o bell'g.

1933-1938 The FDA launches an intensive efTort to .krt Ihe public to the shortcom;lIb'S oflhe 1906 law by high
lighting such products a~ ",ascarl. die' pill> lnd b.ldness cures Ihot are oUlslde lhe scope of the 1906I.w.

1939 The Fedcnl FO<>d.Drug. alld Cosmeti c Act.

1940Th, FDA mowd from USDA to the newly formed Fedcr.tl Sccurity Agency.

1950 Congress pass.es the Okomargo.riliC ACI repealing much of Ih~ legislation Ihar reslriered m"garlne sal".

1953 Th,· FDA bcco",~"S part of Ihe Dcparlrn,·'" uf Hc.hh. Edllc~"u" and \Vdr~re (H EW) .

1954 Miller I'esricidcs A,m'"dmclll ~"'powers th .. FDA 10 ,'srabltsh lulcrancc! for l,cSI,,;de!.
1957 I'ouhry I'roduC!~ IIIsp<:clw" An (I'I'I").

1958 Ddalley Clau,,- "1 the Food "dd'lIw A"w"dllwUls l<J ,h~ 1939 Act .... q'lITel tlm ~ food or wlor oddllwc.
01",' deternll"cd to be ~ c.relllog,·". 1101 be appro""d for food U$,'.

1958 Fuod Addu"'e Alllcllthnnm reqlllre pre -market JPpro"al for ,ww food IIIgred"'III' (before,. IIIJrkct<"r could
add lIlj;t<·,hCII\$ ",,,hunt 'I"'cific FI)A "PIln,,".II).

1960 Color Addll,,"e Ame"dll1<'111.

1966 Th,' FDA I'ropo,cs rc,trictiw approach \I) foud f"r11fic~ti,,,,-

1966 F,;r I'Jcb!:l11g and Lab,'III'g An cOII'I'I,·tdy ,,'structure, Amc<IC'II fOOlI I,bds, o'lSIIIIl o"e major food
COIllI,.ny to change 20.0(10 bbd,.

1967 Whole,o"", Melt Act .• ",elldms th,' 1906 M,'a, In,pectlon Act (M IA ).

1968 Whole'olll<' 1'0,,11<)' I'rodnc!' Ac! .• mclldlllg the 1')57 I'I'IA.

1968 The FDA mow' to the I'ubli c I-ka lth Sa"",,' with", H EW.

19(,9 !'reM,k'lI Il,ch.rd N,,,,,,, COllven," 0 Wh",· 11011'" Co"f,'",nec "II Fuud. Nutr""''' ,nd Il e.I1h <I,.,
recon,mend, fornfic.lion of e,,;"mg and new food products 10 mcci ,,,t;Oll,1 I1\lIrlllonol ""I'ds (lh;,
m'w 'l'pro.ch. rC\"I"r,mg ,he 1966 FDA 'talle,·. cre"lr!; new ngllblloll' bawd IJrg,'ly 011 footl-IJbdmg
r("IUln:Ill~nu ra,h~r lh.u on rlg"t ,llll,J.nl$ for nutrient 'ompo,iliou),

1970 Egg Products InspCClion Acl." respon,e to J growntg problem of $nl"""'rl/,, ",feclloll.

1976 V;'~n"n_Mme .... 1 Ame"dmclI!.

1977 Cong"'" PlS"" 'he fir-<! of <e"nal bws precludmg fDA OCl'OIl to b.1l til<" "'" ofsacch,rlll .nd dlreclS the
I:DA 1101'0 impkll\<'m a propl»~d SY'lem for controlhng ,h,' '.lnit.ltion of,hdlfhh.

1980 Th,' fDA', dcpartm"111 "'n,mcd He,llh Jnd ! lun"'" $<',,,,(e, (L> HHS) wh,'" Edun"on b"comc, ," own
d<"l,artn'<·111.

1980 Congre« 1''''''' ,he ln f:"'t F",m"b Act. "npo'I11" drughke re'lu"emc"'s on ,nf."t form"I ••.

1990 Congrc5S pusc< thc Nut"'''''' Labehllg .IId Educolion ACI.

1994 ConK"'!..' passes th., l),etlrY SUl'pkmcm Health Jlld Educ";on An. sc\"CTc1y reurlcllug ,he FDA', Juthorlly
'0 reJ!;ub,,' h""1311 ""'C'110Ilal food,.

1995 CDC, the USI )A. 'IId thc FI)A "lit laIc a S"ntmd $i,,' SurwillJIICC jlI'oJcct, know" "ow .. FoodN"t. 10
coliecl Ilreels,' ",for"'3t")11 about 'he II,,"idellce of foodOOme illiles •. csp<'ClJlly ,11",'15 c~n,,"d by ml"",,,,II,,
Jnd I" lOU 0157:1-17. (FIIld,""s frolll dl<' project sho,," ,h a, Cnmpy/obllrlfr CJU,,', Ihe ""J0rlly of'lwrothc
,1111e'I<" JSloc;Jlcd wilh II1l'0t alld pouhry products).

1996 The U~I)A p"bl"hc, ItS I.ndm.uk rule on I'JthoKe" Redu '''on and /-I n"d ... naly,,, "nd Cr",eal Control
1'0"'t5 (HAeC I'). which e<l"hli.h~, "'-I,lom p"rfor"'"nc~ <ulldards for S"/",uudl,, ond od1["r foodbo",<'
p,lhog<,lIS.

1996 Th,' Food $;,fety 'lit! In,p" ,'"0n S... "jc(" (FS IS) c""duclS ,c,ti"S for tl,,' first tim" '0 enSure d,a, th,''''
'Iandard. are m<" (the firs, such performallce ,,,"dnd fur a broad "nge of meJt "lid poultry product< ,h,t
ne r,"'").

1997 The 1'''"5i<l''I1I'' F"od Safety 1"""II\'e adds ,,"lholl' of dollar< '0 the O'IlO,,'s fo<.>d "f,·ty budS"', impro"",s
coor<ima!1on bctween food "rety regubtory "Kell(;"5 ond survc,lbnce for foodbo",e disease •.

2002 TIl<" I'ubh, HCJltb Sccurlty Jnd IllO,crrori <m I'rcp""'d,",,ss .nd Rc~pomc Act, kllown a< Ihe lliot<'rrUrI,m Act.
~dd, ),'((1011 311~{h) 10 Ih, 1939 Fe,krnl Food. Drug .• lId Cmllle" .. ACI. all<.>w;nS ,hc dc"""oll of ,u'p"n
food product,.
13U MIIes!!"I"< Chapt,'r 7 S It"r .111<1 ! [rJlt["~r food, Lookml: [I.llk

Protecting public health involves layers of control before

food reac hes the consumer. The first layer - industry's clear
responsibility to prepare safe food - must be monitored by
a second layer - regulatory agencies - to ensure th:lt the
food industry does it~ job :ll1d produces safe food. In the
policylllaking arena for food safety in the United States,
sc ience and risk analysis are paramount. ~ Th e federal
government's current efforts focus all the risks a%ociarcd
with microbial pathogens, trying to reduce those risks The federa l gov-
through a compre hensive, farm-to-table approach co food ernment's current
safety. These efforts foHow many yea rs of managing chemi- efforts roc us on
cal hnards in the food supp ly by regulating additives, the risks associat-
drugs, pestic ides, and other chemical and physical haz;lrds ed with microb ial
considered dan gerous to human health. Since biological pathogens, trying
h;lZ;lrds differ from chemical hazards, the science of food to reduce those
safety has been transformed. risks through a
comprehensive,
For eX;lm pl e, the U.S. government's now-completed risk farm-co-table
analysis of Salnwndla enteritidis in eggs and egg products approach to food
included the first farm-to- [able quantitative mi crobial risk safety.
assessment. The government has also conducted a risk
:111a lysis for E. coli 0157:H7 in ground beef and has entered
inco a cooperative agreement with Harvard University
ror a risk assessment of Bov ine Spongiform En cephalopa thy
(mad cow disease) transmission through foods. Yet another
risk analysis for Lis/eria IIwnocylogelll's in a varie ty of rcady-
co-ea t foods has also been carried out.

Food safety in th e United States is both highly centralized,

through the FDA, the USDA and CDC, and decentralized.
Each state has its own food, drug and cosmetic ;let, while
the Federal Trade Commission (FT C) regulates advertising
of food ;llld rood products under the terms of the Federal
Trade Commission Act. Some kinds of food , particularly
milk and d;liry products, are also regulated at the county or
city level. Milk shippe rs Ca ter ro differing ordinances th;lt
regubte expIration dates on milk products , sometimes in
neighboring cities withill the same state.

The FDA serves in a public health capacity. [n the early

19705, imported products regulated by the FDA numbered
approxim.:ltely 500,000 formal entries each year (e.g., those
v;llued at $1,250 or 1110re).ln 1992, these products accoun t-
ed ror 1.5 million formal entries, of which 78 percent
 (1, 11 7,000) were food produc ts. Uetwce n 1987 and 1992 ,
detentions of food produ cts nearly doubl e d from 14,104
to 27,865 . C lcJ rly the FDA serves a vital fun ction III
protecti ng public healt h.

Am erica ns now f:ICC a crossroads concernin g th e issue of

sa fer an d healthi er food s. Mu ch of the regulatory piece

, enSUrin g food safety is in pla ce lnd working we ll, although

it should neve r be ta ken for gralHcd. ~ What needs
work is Individual commitment to healthier eating and an
What needs active lifestyle. Less suga r, more whole-grain ce rea ls and
work is individual breads, three to four fresh fruits a day. green vegetables
comm itment to :lI1d so on, co upled with e xercise routin es could make
healthier eating a remarkabl e difference in th e overall health of th e
and an active
Am e ri can popu1:ttion. D
lifestyle.
Case Study
Jack in the Box E. coli Outbreak

Jack in the Box restaurants, founded in Sail Diego III 1951 ,

popularized the COll cept of " drive thrll" dining, a fite o f
passage for many American tee nagers and a conveni ence
for workin g parents who have little time to prepare meals.
After th e founder, Robe rt 0. Peterson , ex panded his
modest h :llllburger restaurant into :J. c h ain th:lt stre tch e d to
Arizona and Texas, l"talsto n Purina acquired a controllin g ' '1'
Tlte firs! Jilek ill
inte rest in 1968 and pursued an aggressive expansion st ra[e~ Box ill 5011 Diego
gy. By 1979, there we re mo re than 1,000 "drive thru" Ja ck ill 1951.
in the Box restaurants in 32 states. A period of corporate
restru cturing foll owed, Including a pullout from th e Ean
and MidwCH in 1986. Today, Jac k in th e Box thrives 111 its
intended markets in the West and Southwest, in part
because the publi c in thcs~ states admires th e way Jac k in
the Box respon ded to a serious crisis ltl Seattle in 1993.
That crisis awakened the federa l government to the fact
that its established ltlspec tion syste ms for food safe ty had
fail ed to protect th e public health . The c risis also intro-
duced the co untry to a microorganism, Escllcrichi(/ w/i
0157: J-l 7, which has since beco me familiar to many.

E. (oli 0 157:H7
 Escherichia wli (£. coli for short) was identified in 1885
when the German pediatflclan Theodore Escher ich first
described the bacteria. These rod-shaped bacteria, profuse
throughom the d igestive system and usually benign, keep
disease-ca using bacteria from taking over. The 0157: H 7
strain, however, is f.'lT fi'olll benign, as events in Seattle in
1993 Wl'Te to prove.
Isolated and identified for the first tillle ill 1982, E. wli
0157:H7 is a problem in red meat, particularly hamburger.
The d iscove ry came during an epidl'lllic in Oregon and
Michigan caused by undercooked hamburger patties sold in
T/u'oliort' Eschrrich
the McDonald's f.1St food chai n. At the time, public health
first drscribrd Iilr
hl/Clrrill, /lOW (Ill/I'd officials viewed the Olltbreak as an isolated incident. Ilot an
Esc herichia coli. omen; in fact , E coli 0 "15 7:H7 is the third most de:ldly
bacterial toxin , :lfter the bacteria that causes tetanus and

, botulism. Its distinctive symptOms are bloody diarrhea and

fierce abdOllllllal cramps. .. Many patients describe
the pain as so severe that it feels like :l hot poker searing
Many patients their insides.
describe the pain
as so severe that it DlIfing an E. coli olltbreak, between twO and seven percent
feels like a hot of patients - mostly young ch ildren and the elderly-
po ker searing develop hemolytic urellllc sy ndrome (HUS), which can
their insides. lead to death . H US sets III when Shiga tox ins, emitted by
E. wli 0157:H7, ravage cells lining the intestines and cause
bleeding. Th e bleeding permits the toxins to enter the cir-
culatory system, and wht:n this happens, the damage is very
similar to that of rattlesnake venom. The toxins tear apart
red blood cells and platelets, and the victim beco mes vul -
nerable to br:lin hemorrhaging and ullcontrolled bleeding.
Clots form in th e bloodstre:lm and block the tiny blood
vessels around the kidneys, the heart's middle layer :J. nd [he
brain. As the kidneys g ive Ollt, the body swells with excess
waste fluids, and complications ripple through all m:J.jor
organ syStems. Stroke, blindness, epilepsy, paralysis and heart
f.1ilure can result. Although donors know how to m:J.n:J.ge
H US symptoms and arc researching new ways to stop the
toxin, there is currently no cure or effective treatment.
[n 1993,Jack in the Box rest:lur:lIltS promoted its most
popular menu item, the Monster Burger, as "So good it's
scary:' Eleven years after undcrcooked hambl1]"gers at
McDonald 's caused outbreaks of E. coli 0157:H7 in
Micillgan and Oregon, a much graver crisis struck Seattle.
A Jack in the Box restaurant served undcrcooked Monster
Burgers and killed four children among more than 700
people who became ill.
When the Jack in the Box tragedy struck, 22 previous out-
breaks of E. coli 0157:1-17 had already killed 35 people in
the United States. Not until the Seattle olltbreak, however,
were f:1st food hamburgers, a staple of American culture,
viewed for the first tim e as potentially lethal. Pu blic health
investigators from Seattle/King Coull t)' Department of
Health, aware of the previous E. coli outbreaks, zeroed in
immediately on undercooked hamburgers as the outbreak 's
likely cause and quickly identified the particular Jack in the
Box restaurant in Seattle as the source.
Tracing where the con taminated meat came from, however,
was no easy task . A single ca rcass, whe n shredded for ham -
burger, has the potential to pollute up to eight tons of
ground beef. .. In the Jack ill the Box outbreak,
investigators quickly identified the supplier but found that
,
the ground beef contai ned meat from 443 different catde .the (contami-
that had com e from five slaughterhouses served by farms nated) ground
and allction in six states. beef contained
meat from 443
How does meat become contaminated? Cattle produce different ca ttle
abundant feces, whic h contain bacteria; when the feces that had come
are passed back and forth in crowded feedlots , as they from five slaugh-
inevitably are, microorganisms like E. coli spread. Cattle terhouses served
fed on grass seldom carry the orgalllsm. However, cattle by farms an d auc-
fed on corn, the staple of the feedlot, develop aci d in theif tion in six states.
stomac hs. E. wli has learned to thrive in acid envi ronments
and are now principally a feedlot microbe, very common in
the manure of feedlot animals.
When cattle arrive at the rneatpacking plant and pass
through the door on their way to becoming food, they are
caked with manure tbat comes from sleep in g and resting ill
very tight quarters. U nless the hides are carefully separated
in a way that minimizes contact with the meat, E. wli
0157:1-17 in the manure can contaminate the meat.
Bacteria present in the intestinal tract can also contaminate
the meat. Unfortunately, when E. coli then passes IIno
human stomachs through ulldercookcd meat, the bacteria's
tolerance for acidity means that gastric shock won't kill it.
 It is tbought that as few as 10 bacteria can kill a perSOll
once they release their lethal toxin. When Jack in the Box
became aware of this danger, the company attempted to set
thmgs right. The company hIred Dave Theno, a food safety
expert, to overhau l the company's system of food prepara-
tion. His advice was simplc;" Make sure the meat products
arc fresh, look good, 3re cold, nOt discolored or things tik\.'
that; keep them refrigerated and cold; follow shelf-life
information, coded information . And the n when you cook
them and prepare them, Illake sure YOll wash and s:lIlitize
your hands. Clean your utensils. Ground beef should not
be served medium rare or rare. J uices should run clear.
Internal temperatures should be ove r 155. R are hamburgers
need to be a thing of the past."
After the Jack in the Box outbreak. the federal governmelH
proposed a new inspenio n system - known as "HACC p· ·
(Hazard Analys is and Critical Control Points) - th at
required tll1crobial testing for the first time to detect hart11~
fttl bacteria such as E. coli and Sa/l/wl/clla. Since the start of
this new system in 1996, the USDA has reponed a drop in
Sall/w/lella cotHalllination of ground beef, while the CDC
has seen a dec rease in the incidence of o ther foodborne
dlncsses.
Ame ricans may still face serious risks. however. Incre:tsing
evidence indicates th:lt the modern meat industry's wide-
spre:td u~e of :mtibiotics to promote growth ;md keep live-

, stock healthy results in infectious bacterial strains th:tt

reSist treatment with :tntibiotics. ~ Meanwhile. with
global tr:tde, the risk that dise:tsed c:ttt\c or beef will enter
Meanwhile, wi th the United States and decltnatc the livestock popubtiotl
global trade, the increases.
risk that diseased
ca u lc or beef will A rece nt court ruling may also threaten food s:tfety. In
cmc r the United 2001, a Texas meat-grinding company, Supreme Beef. filed
States and deci- a bwsuit against the USDA afte r it was effectively shut
mate the livestock dowll for failing three bacter ial Coltt;ltllin:ttiotl lests in suc-
popubtion cessio n . One tcst found that nearly 50 percent of its meat
Increases. was comamin ated with Sa/mOl/ella . Supreme I.k ef sued the
government over its right to shut down ope rations simply
because the company f.1iled to meet USDA Salmo/lella stan-
dards. The National Meat Assoc iation supported Supreme
Beef's claim, poiming out that contaminated cattle WCr(.'
the source of Sa/m(JII(:IIIl, not the plant. :tnd the shutdowtl
was, therefore. unnecessarily punitive. In March 2002, a
federal appeals court ruled in (war of the company.
Per-capita annual mea t consumption in the Ulllted States
peaked in the early 1970s at 85 pounds and has since (1ll-
en; in 1995-97, it was down to 64 pounds. In 2001, more
than 100 million pounds of bad meat had to be recalled.
The meat industry's respo nse to the Seattle outbreak and
co ntamination inciden ts since has been a series of high-
tech so lution s, suc h as sprays. A spray based o n milk appears
to kill E. wli. Another solution, passing meat through steam
cabinet.~ in bags o f hot wa ter, kills most of the bacteria.
Finally, irradiation appeals to the meat ind ustry beca use
it is COSt effective. Even with the highest standa rds for
sanitary processing, so me manure may still be in the meat.
Irradiation eliminates the threat posed by manure.
Another, Illllch simpler so lution is possible, recommended
by James R ussell, 3 researcher at Cornel l U niversity. Oy
putting ca ttl e Oil g r3$S or hay fo r the bst sever:d days of
their lives, ch:lllg ing the p H babnce ill their stomachs, the
E. mli popubtion plummets by :IS much 3S 80 percent. The
industry res ists this soluti on, however. To them, it is costly
and impractical - shi ppin g so much hay to feedlots is :I dis-
illcemive, as is lost ga in - that is, cattle losing pounds just
before sbughter.
The politics of meat arc instructive for effective :ldvocacy.
The key associ:l tions - American M eat Institute, N:ltional
Meat Associ:ltion, :lnd Nation:ll C3ttlclllen's Beef Assoc-
i:ltion - target their lobbying activities to :J few key l:aw-
makers and regulators. ~ Despite a relatively low level
of financial contributions, the ind ustry lIsually succceds
,
at preve nting, wcakening or delaying new lll eat safety Despite a rel:a-
initi:ltives. Now that Tyson , the largest poultry producer, tive ly low level
Ius purch ased IlJP, the brgest beef producer, the politics of fill3llci:t1
of me:lt s:tfcty init i:ltives t:wo r the industry even morc. contributions, the
mdustry usually
One demo nstration of the IllC:lt industry'S lobbying m uscle succeeds at pre-
came in 1995 . Two years after thc Jack in the Box disaster ventin g, weake n-
in Seattle, the USDA proposed HACCP, the new food- ing o r delaying
safety regulations for E. Coli and Snillwl1(:/Ia testing in beef. new meat sa fety
The mcat industry, objecting to new testing. convinced a in itiatives .
member of:l key appropriations committee in the HOllse
of Representatives to introduce an :llllendment to stop the
rule-making process, ca lling for the USDA to conduct
 more ex tensive hea rings. This move effectively delayed the
implementation of the new regulations. The meat industry
l1.1s in f:1Ct fought food-safety inspection from the start, not
waming to be held accountable. Even in the (lee of the
Jack in the Uo;.; evidence and ensuing melt safety standa rds,
the beef industry pushed its supporters to counter that the
standards were unscientific and did not improve meat safe-
ty. The industry claims that the incidence of E. w/i in beef
is less th:m one percent .
The good news for government regul:ltors, howeve r, is that
food -safety inspection s, backed by testing, work. PulseNet,
a newly created testing system based at CDC, demonstra tes
how testing brings benefits to everyone. PulseNet is a net-
work of state public health laboratories throughout the
country thar arc now fingerprinting E. coli 015 7 and other
foodhome bacteria o n a routine basis. E. coli 0157 has
many different fingerprints, and usu:"Illy no two will match
A lalmieiml III in a g iven period of tim e. If :"I state public he:"l1th depart-
Pu/st'/"kl lI'o,kiIJ.f? 10 ment sees a string of c;\ses in which fingerprints ma tch or
idclllify fi".I!I"p,iIIS oj CDC lea1'llS of c:"Ises in different states that have matc hing
JOMlbofrU' Iu/claia.
fingerp rints, victims of the outbreak clearly have something
in co millon. Investigations C:"In then focus all those people,
using fingerp rinting to analyze what they have in common.
With the technology up and running;H all state public
health laboratories, compari sons can be made through the
Internet. Connect ions through matc hing fing erprin ts can
be made between E. w/i infection s in as many :"IS 22 states,
a real advantage in identifying outbreaks sooner and in
greater detat! than ever before.
, ... The Jack in the Uo;.; E. w/i outbreak in 1993 informed
th e public and scientific and public health communities
The Jack in the that standards for meat sa fety needed strengthening.
Dox 8. (o li R.egrettably for the victi ms, wa1'lling signs had been ove r-
outbreak in 1993 look ed. Once the threat was understood , however, the
informed the company itself responded with new food-preparation sys-
public and scien- tems that mitigated the threat. Government also played ItS
tific and public part, requiring testing of raw lIleat for invisible bacter ia for
health communi- the first time and upg rading meat- inspection systems. The
ties that standa rds public health and scienti fi c communities are collaborating
for meat safety in tra cing genetic fingerprints of foodborne pathogens,
needed strength- building knowledge in particular of the mechani sms of E.
elllng. w/i 0157: 1-17. Sin ce the outbreak in Seattle in 1993, mu ch
progress has been made. 0
138 Mi!cstoll"S' Ch'p ler 7· S,rer ~"d H e.hh"" Foods· V'gm'uc

Vignette
Nutrition Labeling on Food Packaging
Grocery store aisles co uld easily become classrooms for greater
knowledge about nutrition and healthy eating. Under the FDA and
Food Safety and Inspection Service (FS IS) regu latio ns, food labels
now ofTer mo rc infor mation than ever before. The challenge has
been to educate consumers to rcad the labels carefully, analyze the
information and make healthier food choices. D espite improvements
in food labeli ng, the growing rates of obesity, diabetes, high c holes-
terol and other chronic conditions indicate that people do not always
use food label information in their own best interest. The need for
th e public hea lth com mlmity to continu e educating the public about
tbe use of food labe ls is still imperative.

Start he re ~

Check ca lories
Quick guide
to percent of
daily values
Limit these
nutrients 5% or less
is low

20% or more
is high

Get enough of
th ese nutrients

Footnote

Samplc labelfor HIII(ar,m; al1l1 cirecse.

 139

Today's food labels intend to ofTer consumers:

• Nutrition information about almost every food III the grocery
storc.
• Distinctive, easy-to-read formats that enable consumers to more
qu ickly find the information they need to make healthy food
choices.
• Information on the amount per se rving of saturated f.1t, choles-
terol , dietary fiber and other nutrients of major health concern.
• Nutrient reference values, expressed as "% Daily Values," to help
consumers see how a food fits into an overall daily diet.
• Uniform definitions for te rms that describe a food's nutrient
content - suc h as "light," "low-fat" and "high fiber" - to ensure
that these terms mean the same for any product.
• Claims about thc relationship between a nutriem or food and a
disease o r health-related condition, such as ca1ciulll and osteo-
porosis, and f.1t and cancer, which are helpful to people con-
cerned about eating foods that may help keep them healthier
longer.
• Standardized serving sizes that make nutritional comparisons of
similar p roducts easier.
• Declaration of total petcentage of juice in juice drinks, to help
consumers know exactly how much juice is in the product.
[n November 1990. President George H . W. BLish signed the
Nutrition Labeling and Education Act (NLEA). The act required
the FDA to issue proposed regulations within 12 months and final
regulations w ithin 24 months. By November 1991, the FDA had
published 26 proposals and the FSIS had published a paralle l pro-
posal for [he nutrition labeling of meats and pOllltry.
In January 1992, the FDA and FSlS called a pllblic hearing on the
proposals and received 92 comments in person from food industry
representatives. the scientific community and consumer groups. More
than 40,000 com ments were received in w riting, the largest number
ever received in response to an FDA proposed regulation. Of these,
75 percent were form letters from organized campaigns. Meanwhile,
the FSIS received more than I, I 00 commetHs, most of which
requested that FDA and FS[S labe ls be cons istcnt with one another.
Most requirements arising from the NLEA raised troublesome issues,
such as evaluating hcalth claims related to certain Ilutrients and set-
ting se rving sizes. Food$ we re grouped into 139 categories, with
140

serv ing sizes determined by establishing reference amounts that

represented the amount of food customarily eaten per occasion. HC:llth
claims for certain nutrients WCfC anoth er matter, because little resea rch
ex isted for most claims, whether they were very specific o r broad.
The FDA strove to come LIp with a general set of principles that
cauld be applied across all cbims, and after lengthy and complicated
evaluations, in the e nd, approved seven of ten relationships between
diet and health.
Another challenge was agreeing on definitions. Th e difference
between "lean" and "extra lean," for exa mple, had to be determined
across product lines. The American H eart Assoc iation helped deter-
mine these definitions based 011 different levels of fat , saturated f.u,
and cholesterol for all o f the meat products regulated by the FDA,
including fish and game meat.

Th e final regulations arising from the NLEA can be modified in

the fllture as required. Industry call petition for changes, as can any-
one else, and the FDA will set up a (,ir and open evaluation process.
New processed foods come on the market al! the time, eating habits
change, and the next di et fad li es just around the corner. In f..ct, the
food pyramid recommended by the USDA, representing dietary guide-
lin es for healthy ea ting, changes with so me regularity. In a sense, the
NLEA created a process that never ends.

Tllr {alt'Sf USDA food pymmid.

 141

The brest USDA food guide pyramid, which introduced the most
dramatic changes eve r, offers consumers easy-to-use tips on how to
maintain a heahhy diet. For example, completely avoid ing foods that
are high in f.1[, saturated f.1t, cholesterol and sodi um is unnecessary,
provided the consum er calc ulates average intake over several days. If
o ne me:!.l con t:!.ins hi gh-fat food, it shou ld he countered with several
subsequent meals that contain low- fat foods. In general, limiting
intake of processed foods that conta in fat and added sugars is a good
idea. The USDA now pOStS a customized M y Pyra mid on its Web site,
balancing nutrition and exercise for people of varying age, weight and
physical condition. The site offers the following gene ral advice:
• Eat at least three OUllces of wbole-grain bre:!.ds, cere:!.l, crackers ,
rice or pasta daily.
• Vary your vegetables; cat more dark green and orange vegetables
daily, and eat more dry be:!.l1s and peas.
• Eat a variety of fruit dail y (fresh, frozen, canned or dried will do),
and don't overdo fruit juices.
• Get f.1[S from fish, nuts and vegetable oils, and limit solid fats, like
butter, Hick margarin e, shortening and lard.
• Milk is import:!.nt for getting calcium - ri cb foods, but favor low-
fat or fat-free milks (lactose-free, if necessary).
• Choose low-f.1 t or lean meats and poultry (baked, broiled or
g rilled) , and vary your choices with mo re fish, be:J.tls, peas , nuts
and seeds. Il
Looking Ahead
How to Ensure a Safe Food Supply

A safe food supply depends on improvements and innova-

tions in inspections, irradiation, genetic engineering and
regulations. For example, the use of fingerprinting E. m/i
0'/57:H7 through PulseNet helps to quickly analyze out-
breaks. In th e Jack ill the ilox o utbreak, it was juSt such
fingerprinting that helped limit th e tragedy.
A safe food supply depends on the detention of suspect
food products as they enter o r 3fC shipped within the coun-
try. Suspect food products can even be held in theif country
of origin, as Guatemala agreed to do when raspberries har-
vested there in 1996 were found to be the source of an out-
break due to Cyclospom in the United States. ~
the provisions of the 2002 l3iotcrror ism Act, rhe USDA
Under ,
must collaborate with the Office of Homehnd Security U nder the provi-
both in protecting the public from suspect foods and in sions of the 2002
securing the mammoth food infrastructure of thi s country. Bioterrorism Act,
Farms, fi elds, processing plants, distribution and Storage the USDA mUSt
f.1cilities and supermarkets are all vulnerable to biotc rrorism collaborate with
attacks. SLlch attacks might cons ist of microorgan isms, toxins the Office of
or chem icals imenrionaUy spread to harm th e food sllpply Homeland
or crops, or of a pest infestation. The chall enge for the Security ... in
USDA, given the scope and size of th e food industry infra- protecting the
structu re, is lllunense. publ ic from
suspect foods ..
Irradiation offe rs another solution for food safety. Irradiation
of ground beef and of oth er high-risk meats will likely be
an important public health tool, mllch as pasteurization
of milk has been. The irradiation process used for meats
induces no radioactivity in the meat. Except for the bacteria
it kills, irradiation introduces no important changes in the
meat at all. After irradiation, nutritional values are identical
to what they were before, and the safety of m eat after Irra-
diation should be no issue at all.
Genetic engineering is yet an other promising solution for
food safety and productivity. In Hawaii in the mid-1990s,
the papaya ring spot virus (PRSV) threatened to decimate
th e state's second-largest fi'uit crop. By 1998, however,
Hawa iian f.umers were planting seeds of PRSV-resiSlant
papaya made possible by genetic engineering. A team of

PaJiaya croJi dfslmyed
Ill' III I! papayll rillX spot
Ifims.
Fltll'r SllI'r 101ll11/{lfS,
111/' frm gfllC'liw/ly
nlXillC('fcd proilllri
markell·d ill lilt, U.S.
..
. .
researchers from academia, industry and the government had
isolated and copied a virLlS ge ne, tben used a gene gun to
shoot the gene into cells of the papaya plant. The papaya cells
integrated the virtls gene into their own chromosomes, mak-
ing the papaya and subsequent generations resistan t to the
virus. While food products derived from genetic enginee ring
remain contmvcrsial, the Hawaiian papaya f.1Tmers have qualms
ne ither about the process no r the products. Genetic engi-
neering saved their llvclihoods.
The fi rst genetically engineered product in the Uni ted
St3tes went on the market in May 1994 when the FDA
approved a new tomato that could be shipped vine- ripened
without rotting. The FDA determined that the genetically
engincered tomato was as safe as other commercially grown
tomatoes. C:ll!cd the Fl:lvr S:lvr, the tomato h:lS g:li ned wide
accept:lnce in this co untry, especi:llly during timcs of the
year when fresh-pickcd tOIll:ltoCS are unavailable. In the
European community. howcver, gcnctic:ll1y modified foods
have caused much greater COlHroversy and are actively dis-
couraged by regulators. On the other hand, American con-
sumers have found that genetic engineering otTe rs a gre:lter
variety of reliably s:lfe foods, bro:ldening the range of :lvail-
able nutrients during nongrowillg months.
Regulatio n offers othe r solutions for food safety. The
doses of subtherapcutic antibiotics :ldrninistered by farmers
to poultry, swine :lnd penncd fish ill overcrowded f.1cilities,
to diminish Incidence of disease and encourage faster
growth, result in resistant str:lins of Sallllmlella :l.11d other
food borne pathogens. A partieularly aggressive strain of
resIStant Sa/molld/II h:lS been identified as DT 104. Although
policy dec isions must rely 011 accur:ltc research , it is already
:lpp:lreIH th:lt regulation of feedlo ts and othcr ove rcrowded
:lni mal facilities must be stepped up. The overcrowding,
itself a problem, is often compou nded by rec kless use of
:lntibiotics, :lnd f:1 rlllers need to be held to account if resist-
ance is to be controlled. Regulators also need to look to the
food industry in general - processing plams, food distribu -
tors, restaur:lll ts and sllpe r!llukets - to bring the problem
under control. The lise of antibiotics by f.1rmers, a response
to the impe rative of controlling coses, call be tllirig:lred if
the links higher lip in the food industry <Ind, uh ilnarc1y,
the public insist that cattle, eggs, pigs, poultry and sheep
be raised to market readiness in hu manc conditions
,::' '.- .p;'.-' . ,
~ ,
without undu e use of antibiotics. To th is point, the food
indu stry wi tn essed a "Save the Dolphi ns" cam pai gn that
became so popuhr that tuna-fishing methods changed in
response.
Educat ion , anoth er important aven ue for improvin g food
safe ty, must encourage fundamental research on the natural
history of human pathogens in animals. How do these
microorganisms develop disease resista nce and how is it that
they produce toxins? Educatin g those invo lved in prodllc-
ing, transportin g an d pre paring food , including consu mers,
can help stem the threat of serious foo dborne illnesses.
... Food behavior must first change with individuals in
their homes and ca n be as sim ple as keeping perishable food
,
refrigerated, keepi ng food co ld before pre parati on and Food behaVIor
cooki ng food properly. Fo r hambu rgers, chi cken and pork. mmt first change
t his means using a food the r mom ete r to determine th:H rhe with individuals
111 th eir homes
meat is thoroughly cooked. If restaurants followed these
simple rul es, the incidence of foodborne illnesses would and ca n be as
decline dramatically. simple as keeping
pe rishable food
Th e U.S. DepanlTlenr o fTransponatiol1 (DOT) regula tes refrigerated , keep-
condition s for the transpo rt of ed ibl e produ cts. [n J uly ing food cold
1994 , Co ng ress passed a transpo rtation bill that contai ned before preparation
prov isio ns address ing the sa nitary transportation of food. and cooking food
The rcgubtions, still goin g through an approval process, will property.
address prope r tempe raUire in refrigerated trucks amo ng
o th er issues . For now, the FSIS has no comprehensive regu-
h tory program that governs the handlin g o f meat, poultry
and egg products once th ey kave a regu lated pl:lllt . As of
now, a mishmash of state and loca l regulations govern th e
tr:lIlsportation of th ese per ishable goods from the time they
leave the plant to the time they reac h the consume r.
C DC's abi lity to mo nitor food borne illness outbreaks
improved significantly with the President's Food Safety
Initi at ive of 1997. CDC now o perates some 20 survei ll ance
systems, incl uding the two main systems, FoodNet and
PulseNet. FoodN ct is an "active" surveill ance system chat
enco mpasses a po putati on of 20.5 million Americans in nine
geographic areas. The system collects outbrea k information
o n nine foodbo rn e pathogens, toxoplasmosis, H US, and
GlIillaill- [brre syndro me. On ce information is coll ected.
FoodNet estimates the burden of illn esses, lllonitors trends,
and names specific fo ods that ca rry risks. CDC also now
funds nine Envi ronmen tal Health Speciali st (E HS-Net)
 I-IS

states where research is conducted on the f:1Ctors that most

often cause illness and the best means to prcvellt illness
in food service operations.
According to Ern est Julian, PhD, Chief of the Office of
Food PrOtection at the Rhode Island Department of
Health , many states, but nOt all. have mandatory training
and certification for managers of food service o perations.
A recent study conducted by CDC found that establishments
without a ccnifi(..'d manager were more likely to be assoc iat -
ed with food borne outbrea ks than those with a certified
Dr. ErIIl'sl jllli/III, man;l.ger. Simil arly, th e FDA fOlllld that establishments with-
cI/J4 of II", Q{JiCI' out a certified manager were stati stically more likely to have
I!f FOMI Proll'CliOIl, certain risk factors present that are associated with food-
Rirode Isldnd borne ombrcaks. Julian observes, "Th ese studies provide a
Oepa"",('III sound basis fo r aH health departments to require mandatory
".f /-fealll,. food manager training and certification. While fo od ma nager
certification is a critical component, inspectio ns arc still
needed to ensure that th e establishment has a certified
manager as required and co make ce n ain that there is
compl iance with other requir~d food safety practices."

In the Cll rr~nt feder;l.1 food-s;l.fery system , 12 different ag~ll­

cies enforce 35 different sta.tutes, which can lea.d to bureau-

, cratic conflicts that undermine both enforcelllt: nt an d pre-

ve nti on efforts. ... If federa l food safety responsibiliti es
w~re consolidated into a single agency - from fa rms and
If fede ral food- feedlots to tfll cke rs to processing plants to retailers - the
safety respo nsibili- atte ntio n accorded food safety wOl11d be much Inore
ties we re consoli- foc used and unified. Consolidation would also strengthen
dated into a si ngle prevention efforts . Suc h consolidation remains only a
agency. .. the atten- dream, however, and perhaps unrealistic in the face of
tion accorded many special interests in the food industry. While the
food safety would public health co mmuni ty puts public health first, the food
be much more industry - farmers, processing plants, food distributors and
fo cused and superma rkets - have a different concern, putting their goods
unified. first. Hence, the publ ic he;l.lth commu nity and govern ment
regllbtors, despite noteworthy ;l.dvances in food safety, 1l1ust
remain wary. IJ
 Photo cred iu
I'agl' 123: E.r1y American Store, Q Ikmu3nn/COll.LlIS.
I':lg~ 123:Trueks 1111('d up ror NAFrA bord,'r lUSpt'ruou, " SII"-C St.1rr/COItIlI~,
l'~j(~ 124: L\lnch al:l day em: ",'llta, 0 A"uic Griffiths Udt/C()ItUlS,
I'age 125: G.len, courtesy Tht' NatIonal LibldTy of Mt',hcIIle,
P'ge 126: Dr, I hrwy W. Wiley Sl~ml" 0 FDA/CFSAN.
Page 127: Pdlagra victim, L"SII'TV. UI',!!man/COItU1S.
l','ge IJ2: E. coli, 0 Gary Gauglrr / Visuals Unlimitnt.
1':I!!C IJ7: Puls"Ncl t,'chnician, courtesy CCnt(·rs for D"raSt· COlllml
:",,1 I'rc\"Clltlon.
PJj(" 1010: Myl'yr,u"d, court~"'Y of www.Myl.yr:lI.ud.Go\".
P'j(' I.jJ: Pal"}"' Tlng sl'ut "ITll<, enuTtl'S}' Carol ,ml 1)"",,,\ Gon~l\"c~, fn>t1l tilt'
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