With recent outbreaks of E. coli in beef and salmonella in peanuts, sitting down to dinner may seem hazardous to your health. Can it really be so bad? EatingWell investigates.

With recent outbreaks of E. coli in beef and salmonella in peanuts, sitting down to dinner may seem hazardous to your health. Can it really be so bad? EatingWell investigates.

First, he goes onto the roof. It will be industrial: flat and expansive, likely covered in crushed gravel or a thin veneer of asphalt. The roofs he walks cap long, low, stolid buildings, often situated in the midst of vast expanses of near-nothingness. But that's OK. He's not here for the view. Indeed, he is looking toward the center of the roof, where a pair of huge, spiraling cones push into the sky. They are venting the air-and anything that rides in it-from the building's interior. Sometimes, around bases of the vents, he'll find detritus from the industry below. At one facility where cheese was produced, it was powdered milk. Pigeons were gathered about, feeding on the bounty. Peck. Peck. Peckpeckpeckpeck. He knows birds carry salmonella and he is pretty certain he's found the source of the bacteria he's been called in to investigate. Once the contaminated milk powder gets kicked up by the wind, it will drift back down through the vents or, in a rainstorm, liquefy and drip through a leak in the roof. "In every factory, there's a Bermuda Triangle, where everything comes together to create a source of contamination," he tells me. "A lot of times, the Bermuda Triangle involves the roof."

Scott Donnelly is one of our country's top experts in microbiological food operations. He is an independent contractor, hired by a privately owned company (which preferred not to be identified) that helps food manufacturers identify sources of contamination. From his home in Burlington, Vermont, Donnelly flies to Georgia, California, Texas, Louisiana. He inspects facilities that process peanuts, cereal, frozen pizza, cheese, ground beef and energy drinks. It is a job that, of late, has been particularly busy for him, as the industry grapples with the recent spotlight on food-related illnesses.

Good Food Gone Bad

Beef. Peanuts. Spinach. Pistachios. Cheese. Alfalfa sprouts. Bad news-and bacteria-seem to be lurking in every corner of our cupboards and refrigerators. And these are just the recalls that have made national headlines. In fact, a quick visit to recalls.gov, a federal website, reveals an alarming array of recalls: cheese tainted with listeria, curry spice contaminated with salmonella, ground beef infected with E. coli. Maybe that's why, in a recent survey conducted by the American Society for Quality, 73 percent of respondents expressed concern over our country's food-safety record.

But should we all be concerned? According to the Centers for Disease Control, Americans suffer an estimated 76 million cases of foodborne illnesses every year, necessitating 325,000 hospitalizations and causing 5,000 deaths. Most experts agree that outbreaks are severely underreported. "For every one person counted, we're probably missing nearly 40 others," says Bill Marler, who describes himself as the "nation's leading foodborne illness attorney." This descriptor is probably fair: since 1993, when Marler represented victims of the nationwide E. coli outbreak that was traced to Jack-in-the-Box fast-food restaurants, the Seattle-based lawyer has secured over $500 million for his clients (and surely a pretty fair chunk for himself). "To be honest, I never thought I'd make a living out of this for this long. I assumed we'd catch on and fix the system. But even with all these outbreaks, nothing is structurally different. It's like no one's paying attention, except the people getting sick."

Fortunately, most people who eat contaminated food don't become seriously ill. But the same contaminant that causes a stomachache in a healthy adult can be devastating to the elderly, anyone whose immune system is comprised by a condition like cancer, and the young. Elizabeth Armstrong is the mother of two sweet-faced daughters. Ashley is five; Isabella is seven. They live in Fishers, Indiana, a town of 66,000 just north of Indianapolis. Three years ago, in late August, the family sat down to a raw spinach salad that would change their lives forever. The spinach the Armstrongs ate looked and tasted like spinach is supposed to look and taste. But it carried Escherichia coli O157:H7, a tubular-shaped bacterium known to cause kidney failure, particularly in young children. Ashley and Isabella were about to become two of the first cases associated with the 2006 E. coli outbreak that would eventually be traced back to a 50-acre farm in San Benito County, California, where it's now believed that wild pigs tracked contaminated manure from a nearby ranch to the spinach field. Before the outbreak was contained, three people would die, 31 would suffer kidney failure and at least 204 people in 26 states would be sickened.

Within a week of eating that fateful salad, Isabella suffered a bout of diarrhea; as she began to recover, Ashley became sick. This time, there was blood in the stool. The Armstrongs didn't know it yet, but their 2-year-old was in the early stages of hemolytic uremic syndrome: an interwoven mesh of blood platelets began clogging the latticework of capillaries in Ashley's kidneys. A day later, she was hospitalized. Two days later, she started dialysis. Today, she survives on a severely restricted diet, six daily medications and weekly injections that coax her body into making red blood cells. In the next few years, likely before she becomes a teenager, she will require a kidney transplant.

"Buying food in this country is truly just an act of faith," says Elizabeth Armstrong. "People are naïve if they think the government is going to keep them safe." In a sense, Armstrong is right, and to understand why, you need to understand how the safety of our food is ensured. Or how it is not ensured.

Who's Responsible?

There are two governmental agencies tasked with monitoring and inspecting our food supply. The first is the U.S. Department of Agriculture (USDA). Through the agency's Food Safety and Inspection Service (FSIS), it oversees all domestic and imported meat, poultry and eggs. The other agency charged with keeping food safe is the Food and Drug Administration (FDA). It's responsible for the safety of our domestic and imported fruits, vegetables, seafood, dairy and grains, as well as processed foods. While the USDA puts an inspector in every single slaughterhouse, every single day, the FDA conducts inspections an average of every seven years. Only about 1 percent of the food showing up on our shores is examined for contaminants. That's particularly alarming when you consider that 79 percent of our fish and shellfish is imported, along with 32 percent of our fruit and nuts and 13 percent of our vegetables.

So, yes, buying food in the United States is an act of faith: faith in the grower, the processor, the wholesale distributor, the shipper and the retailer, because at each junction lies the potential for contamination, and at very, very few of these points are inspections happening.

Yet most of our food is safe, and technology that kills E. coli, salmonella and other foodborne "bugs" is readily available. The USDA mandates pasteurization-the intense heat treatment that, back in the 1860s, French chemist Louis Pasteur discovered killed bacteria-for all milk that enters interstate commerce. Irradiation, or zapping food with tiny doses of radiation, is sometimes used to sterilize meals for hospital patients, and irradiated beef patties are available in supermarkets nationwide. In August 2008, the FDA ruled that iceberg lettuce and spinach could be irradiated too.

If the spinach that Ashley Armstrong ate three years ago had been irradiated, would she have been spared the dialysis and intensive medical interventions that keep her alive today? Yes, says Douglas L. Archer, Ph.D., associate dean for research at the Institute of Food and Agricultural Sciences at the University of Florida in Gainesville. "But we don't have the capacity to irradiate everything today. We just didn't invest in those facilities." Should our food industry be investing in the facilities? "Yes, but that's me," says Archer. "A lot of other people think it's some kind of voodoo." Indeed, many consumers view irradiation (and even pasteurization) with a great deal of skepticism, arguing that they are "unnatural" or, at the very least, unnecessary measures that compromise the taste and nutrition of farm-fresh foods. And even if irradiation might have prevented the illnesses and deaths associated with the E. coli-contaminated spinach, the technology doesn't guarantee absolute immunity from foodborne illness. "We can't just say, ‘OK, we'll irradiate stuff and that will be the end of all problems,'" says Archer. "It just isn't that simple." No food is 100 percent safe. It was pasteurized milk-not "raw" milk-that carried the Listeria monocytogenes that was responsible for the three deaths and a stillbirth in Massachusetts in December 2007. (Health officials believe that the products were somehow contaminated after pasteurization.)

Multifarious Mishaps

Bill Marler believes there's no single solution to the food-safety issue, because there's no single cause. Is it a lack of good sanitation practices by the people who grow and pack your food? Yes. Is it a complex supply chain that creates numerous opportunities for bacteria to invade? Yes. (Even if slaughterhouses are pristine, can you trust the guy working the meat counter at the supermarket?) Is it, as the manufacturers of our foodstuffs would like to have us believe, our fault for improper handling of our dinner? Once in a while, perhaps, but usually not. Still, in Marler's experience, one factor reigns supreme. "Ultimately, the problem with our food system is that it's so industrialized, so centralized, that any little problem becomes amplified."

Consider the recall of 3,916 products containing peanuts sourced from the Peanut Corporation of America (PCA), which, before the largest food recall in American history forced it out of business last February, supplied peanuts to such food giants as Keebler and Trader Joe's. It wasn't just the nuts that had to be avoided; it was anything that contained even traces of the nuts. No surprise, then, that the salmonella-contaminated peanuts from PCA found their way to 46 states, sickening 714 (or, if Marler's one-in-40 figure is correct, 28,560) and possibly contributing to nine deaths. The recall ultimately cost American peanut farmers and food manufacturers more than $1 billion in lost production and sales, as products were yanked from supermarket shelves and crops were allowed to wither in the fields. "This is going to sound kind of cold, but let's forget about the human toll for a minute," says Marler. "Wouldn't you think that merely from an economic perspective, we'd be taking this more seriously?"

Not everyone agrees that we're not taking it seriously. "One of the reasons Americans are seeing so much coverage recently is because we are trying to get out in front of these problems," says David Acheson, associate commissioner for foods at the FDA. "We are finding more because our monitoring is more sophisticated and our messages to the public are broad because the distribution system is so complex. We have to cast a wide net." A recent study on food safety by the U.S. Department of Health and Human Services shows why: only five of 40 products sampled could be traced to their raw-ingredient origins. The supply chain is simply too complex to know, with certainty, the genesis of most of our food, and this begets one of the principal hurdles in holding processors accountable.

"The bottom line is that if you're the CEO of a food company and you're a betting person, you know the odds of an outbreak ever being conclusively linked to your company are minuscule," says Marler. Too, the varying incubation periods of foodborne illnesses make it extremely difficult to pinpoint a particular meal. Think about how many different items you've eaten in the past two weeks, and then consider the hundreds, if not thousands, of ingredients, all funneling down the food-supply highway to your dinner table. Pinpointing which one of those is responsible for your upset tummy is needle-in-the-haystack work.

Scott Donnelly agrees with Marler that some companies simply play the favorable odds: "The food industry runs on incredibly low margins. For most of these companies, it's a struggle just to survive. Sure, some of them are truly committed to quality and they're willing to do what it takes to keep their product safe. Others want to do the right thing, but may be constrained by what they can do, especially by the difficulty of properly training temporary workers. But still other manufacturers are saying, ‘Well, yeah, salmonella makes people sick, but most of them aren't going to die.' They're either ignorant or unscrupulous, and I'm not sure which is worse."

The Regulation Situation

In a sense, it doesn't matter whether it's ignorance or a lack of scruples on the behalf of the producer, because the truth is that in the current regulatory environment, both are allowed to persist and the end result is the same.

"The FDA is basically asking the industry to ‘do a good job, please,'" explains Patty Lovera, assistant director at Food and Water Watch, a nonprofit consumer-advocacy organization that works to ensure safe, clean food and water in the U.S. "The FDA ends up doing a lot of recommending to the industry, when they should be doing enforcement." It's not really the agency's fault, Lovera points out: "It's just too easy to underfund the FDA's efforts." The funding that supports the FDA's food-safety regulations is not written into law; it must be continually re-allocated.

The USDA is somewhat better off, since the funding and policies that guide its food inspection have been cemented in law since the early 1900s. But times are changing, and Marler is quick to point out that the USDA isn't changing with them. "Yes, it's law that a USDA inspector has to visually inspect every carcass that comes through a slaughterhouse," explains Marler. "But you have to ask yourself: does it do any good to be looking for things that can't be seen with the human eye? This is a protocol that was implemented at a time when we weren't even sure that germs caused disease. Maybe we should think about an upgrade." In Marler's view, this means changing the entire focus of the inspection process. "We shouldn't be looking at the meat, but at the procedure," he explains. "We have the technology and the thought process that allow us to create systems to reduce contamination. Our focus should be implementing and monitoring those systems, not staring at meat all day, looking for things that can't be seen."

But inspectors do more than just look for invisible bacteria. The USDA requires every slaughterhouse and plant that produces raw, ground meat and poultry to design and implement a systematic risk-reduction procedure. These programs are called Hazard Analysis and Critical Control Point (HACCP) systems. Basically, they are "structured thinking" about everything that might go wrong in the flow of production and what steps a plant will take to prevent these problems from actually occurring, says Douglas Archer.

On top of HACCP, meat and poultry plants must conduct routine, random testing of their products for the presence of E. coli. "I think we know that getting a negative sample doesn't necessarily make anything safe. There's always another pound of meat coming on that might contain a ‘bug,'" says Archer. "But [the sampling yields] useful information because if things are horribly out of control, you do get to know that pretty quickly."

While HACCP-type plans currently are required on the federal level only for plants that produce meat, poultry, seafood and juice, some states and industry groups are establishing their own systems for keeping foods safer. For example, in 2007, California farmers, shippers and processors that handle leafy greens (including spinach, lettuce, kale and more) banded together to create the California Leafy Green Products Handler Marketing Agreement (LGMA). Operating with oversight from the California Department of Food and Agriculture, the LGMA is an audit program that ensures that its 118 member companies (which represent 99 percent of the California leafy greens on the market) are implementing science-based food-safety practices that protect against risks including animal intrusions (e.g., wild pigs), floods, keeping detailed records (of water use, soil testing, etc.) and enforcing safe sanitation practices.

Similarly, Archer's home state of Florida recently passed a rule requiring that tomato growers implement systematic risk-reduction practices. "I presume that the feds will be working on a similar one pretty quickly," says Archer. He's referring to the report that President Barack Obama's newly established Food Safety Working Group released this past July. The Working Group's recommendations call for improved handling procedures and enhanced monitoring efforts that will help to reduce salmonella in eggs and poultry and E. coli in beef and certain types of produce-leafy greens, melons and tomatoes. The group is also guiding the industry to establish product-tracing systems.

Fundamentally changing such a large, politicized system will likely take years. Yet there's one action that some people argue would immediately lead to safer food: a shift from the current model of centralized production, processing and distribution to localized food systems.

Is Local Food Safer?

The idea that eating closer to home can help make our food system safer isn't just wishful locavore thinking. "Smaller-scale operations tend to provide a more direct producer-to-consumer relationship," says Lovera of Food and Water Watch. "This makes traceback much shorter, and reduces the opportunities for the producer to shirk responsibility. And when outbreaks do happen, they affect fewer people."

Perhaps without realizing it, Lovera makes another important point: just because you can shake the hand of the farmer who raised your food doesn't mean he won't kill you. Buying local does not mean you're automatically safe from salmonella or E. coli (a wild pig can do the same thing to a small farm as it can to a large one, says Archer). But it does assure a level of person-to-person accountability that's absent from the industrial food chain. "The food industry is pretty much run by marketing people who'd just as soon sell you a pair of shoes or a carpet," says Scott Donnelly. "They push for a reformulation that will appeal to consumers, but lack the technical knowledge to foresee the potential safety shortfalls. They don't care if what you're buying is safe or nutritious. They just care if you buy it."

That's exactly why there's been so much recent focus on legislation. President Obama has been urging Congress to modernize our food-safety laws and, indeed, the prevailing thinking on Capitol Hill seems to be if the food industry doesn't care, we'll pass the legislation that will force them to care.

The first piece of food-safety legislation proposed in 2009 is the most ambitious. Introduced in February, H.R. 875: Food Safety Modernization Act of 2009 would unify the food inspection and regulation process under a single agency, called the Food Safety Administration. And it would mandate that administration to, among other things, enforce safety standards, establish an inspection program, strengthen and expand foodborne-illness surveillance systems, ensure that imported food meets the same standards as U.S. food and establish a traceability system.

This all sounds well and good, but many people worry that increased regulation may threaten small-scale, regionalized producers. In other words, the very businesses we're going to need to decentralize our food system. H.R. 875 seems to have lost momentum; most people are putting their chips on H.R. 2749: Food Safety Enhancement Act of 2009.

The draft bill is 115 pages of nearly impenetrable legalese, but there's little question it would place a burden on food producers and manufacturers, in the form of an annual registration fee ($500, to be adjusted for inflation), as well as increased record keeping. This is particularly problematic for small, low-margin producers, many of whom already operate on the fringe of profitability. "We're going to need to decide where to draw the line between producers that need more regulation and those that would be unfairly burdened by it," says Lovera, who sees pieces of the bill as a starting point and believes other pieces could use some refinement.

Which begs the question: What else can we do? For one, we could start demanding that producers take responsibility for ensuring the safety of the foods they're putting out into the marketplace. Under the current infrastructure, even if a company's private testing reveals a problem, it is not required to alert, well, anyone. Will they do it voluntarily? The Peanut Corporation of America didn't-and according to Marler, PCA isn't the only company choosing to withhold such information. "I am personally aware of situations where companies are sitting on test results that show conclusively that they have contamination, even while there's an inspector onsite who believes everything's fine," says Marler. "To say it's crazy doesn't really do it justice."

Perhaps cultivating honesty requires harsher repercussions for withholding information that can harm people. Not that anyone is calling for punishment on par with the death sentences handed down in China to the men who were implicated in last year's melamine-in-milk scandal that killed at least six children and sickened another 300,000. In the United States, to date, no one has ever been jailed for contributing to death or illness related to contaminated foods.

Or maybe the recent focus on the vulnerabilities of our food system is enough to spur some responsible companies to action: "Last year I was hired to do two risk assessments on a strictly proactive basis," says Donnelly. "These companies weren't required to do this, they simply wanted to be assured that they were doing everything they could to make their food products safe."

Regardless of what motivates it, change is likely to come slowly. And in the meantime, Ashley Armstrong waits patiently for the first kidney transplant of her young life. In the meantime, one-in-four Americans will suffer foodborne illness every year. In the meantime, you, the American food consumer, must bear the brunt of the responsibility for making your supper safe. And Scott Donnelly will still be walking around on rooftops, looking forward to the day he can come down.

Ben Hewitt is the author of The Town That Food Saved (Rodale), out next March.

Additional reporting by Nicci Micco

September/October 2009