I described recently how difficult I found it to explain to a cousin just what all the controversy over raw milk is really about.
When I read the comments on my interview with the California regulator, I appreciated once again how complicated this subject is. This stuff about fecal coliforms, coliform mastitis, SPC, and colostrum contamination is amazingly involved.
Some of the comments, especially as concerns the illnesses of six California children in 2006, cover ground well hashed over here at various times during the last year-and-a-half. I think, though, that the tone of the discussion is more respectful than it has ever been on this topic, which seems to make the current discussion more of a learning experience and less of a pitched battle.
One especially revealing piece of new information, for me, is the California Department of Public Health report Darwin linked to on the campylobacter outbreak in late 2007, apparently blamed on Organic Pastures Dairy Co. (There aren’t that many raw milk dairies in Fresno.) Talk about complicated…or maybe I’m just a little slow. Anyway, here is a simplistic explanation of what I got out of the report:
— Two siblings who had consumed raw milk got bad upset stomachs in late 2007, and one was diagnosed with campylobacter.
— The state asked local public health officials to send along all the cases of campylobacter from raw milk they could identify, and five more were identified.
— The state then asked local public health officials to send along all campylobacter cases they could come up with from the same period of late 2007.
— A small number of departments responded, and forwarded the names of 80 people who had been infected.
— Of those 80, two had consumed Dairy A’s raw dairy products (and two more raw milk cheese from unknown sources).
— In total, eight Campylobacter cases were diagnosed that had consumed Dairy A raw dairy products, and three more were suspected.
— The remaining 76 cases of the 80 sent in by public health officials showed “no common exposures… such as a single brand of poultry, seafood, or travel exposure.”
— Presumably we’ll never know what made the other 76 people sick–whether it was two pieces of salami and 74 different restaurants or.. three pieces of chicken, eight hamburger patties, and 65 different restaurants…or five bad bags of spinach and two takeout orders of sushi and and 15 burrito trucks and 54 different restaurants…You get my drift here.
— The state’s conclusion is “that a limited amount of contminated Dairy A product was available for a brief period…”
Something is wrong with this picture. Perhaps I’m missing something–the report is quite dense and difficult to follow. In the end, I’m left with this question: Are California public health officials so lacking in tools or so incompetent that all they can ever spot with reasonable certainty are cases of raw milk contamination, to the exclusion of everything else?
http://thebovine.wordpress.com/2008/11/17/an-untold-story-the-other-milk-man-sells-raw-milk-and-goes-on-to-win-his-case-when-charged-in-ontario-court/
http://thebovine.wordpress.com/2008/11/18/raw-milk-blamed-for-food-poisoning-outbreak-in-wisconsin-is-this-standard-operating-procedure/
David, regarding the campylobacter report, it is easy to see how this report would be confusing. There appears to be enough data to suggest the illnesses were from the raw milk (see bullets in conclusion section). Keep in mind too that a standard questionnaire by the epidemiology "detectives" asks about more than raw milk – it would include undercooked chicken and contaminated water, for example. Apparently, no common associations were found for those 70+ background cases – this is no surprise with Campylobacter, a very common infection that usually isn’t linked to a particular food using routine public health surveillance.
I am surprised that you did not bring up an interesting finding in the investigation: Campylobacter was isolated from the feces of milking cows at the raw milk dairy. Regardless of the "possible" link between the outbreak and the raw dairy, it is a fact that Campylobacter (a pathogen) was isolated from the cows. However, this is not a surprise – campylobacter is common in livestock/birds from large and small farms (grain and grass fed), as well as wildlife.
Finally, I don’t think it is incompetence, but would agree that resources are a problem. Their report mentions resource limitations more than once.
David, I wonder if the DNA was used to compare the strains. Or if just cultures were done, that could lead to many false pos & neg. Epidemiology=guess work. "relies heavily on statistics for establishing and quantifying the relationships between risk factors and disease"; therefore it is based on outdated stats. And this is science?
http://pmep.cce.cornell.edu/profiles/extoxnet/TIB/epidemiology.html
"Epidemiological studies can never prove causation; that is, it cannot prove that a specific risk factor actually causes the disease being studied. Epidemiological evidence can only show that this risk factor is associated (correlated) with a higher incidence of disease in the population exposed to that risk factor. The higher the correlation the more certain the association, but it cannot prove the causation.
For example, the discovery of the link between cigarette smoking and lung cancer was based on comparisons of lung cancer rates in smokers and non-smokers. The rates of lung cancer are much higher in smokers than in non-smokers. Does this prove that cigarette smoking causes lung cancer? No. In order to prove that cigarette smoking is the factor causing this increase in lung cancer, it was necessary to expose animals to tobacco smoke and tobacco smoke extracts. This was done under highly controlled conditions where the only difference between the controls (animals not exposed to smoke) and treated animals was the exposure to smoke. These laboratory studies proved the causal association between smoking and increased risk of cancer. "
Not to pick arguments with any of the good people who devote their lives to this kind of effort, but I am struck by the wildly disparate treatment, when similarly unorganized observations on, for example, the benefits of raw milk, are dismissed out of hand as "merely anecdotal," and therefore not science.
By "unorganized observations," I mean, studies not conducted according to the clinical gold standard requiring double-blinds, placebo control, rigid exclusions of variables potentially impacting the control and experimental groups, replicability, etc. Neither epidemiology as reported in the campy outbreak, nor raw milk testimonials as I have seen them, meet the gold standard; yet epidemiology is accorded the status of "science" and testimonials are kicked to the gutter as merely anecdotal.
Something is not right with this picture. When Dr. Ted Beals and I and others designed and coordinated reports of lactose intolerance (together with many other observations) in a carefully designed study of over 2200 raw milk drinkers (showing that 82% of those who had been told by a healthcare professional they were lactose intolerant were able to drink raw milk – reported in this column 2/22/08 – http://www.thecompletepatient.com/journal/2008/2/23/at-last-data-on-raw-milk-and-lactose-intolerance-raw-milk-le.html), the report got short shrift by several commentators who predictably, complained the results were not scientific.
Again, I don’t mean to throw stones here. The point is, given the difficulty of conducting gold-plated science when studying the impacts of dietary variables in humans (never mind ethical problems in some areas of such inquiries), I would argue that we should use every bit of information that we can get. And if some of that data is derived from what individuals observe from profoundly important personal experiences, I see absolutely no validity in restricting their freedom to have more of those experiences by arguing that the conclusions drawn from such experiences are not scientifically valid.
I don’t think the Constitution requires freedom to be validated by science.
If regulators think the public needs to be protected from raw milk, I would argue as I have previously, that raw milk simply be identified and labelled with a warning. Those of us brave enough to drink it anyway (no matter what Harvard doctors think), will do so well-warned, and the rest of society can go their merry way. The precedents for this approach to various behaviors are ubiquitous – from the Prop 65 warnings on consumer products (this product contains substances found by the State of California to be hazardous, etc.) to the porn warnings on junk email (don’t open this if you’re not 18), to don’t lean on this screen it won’t keep you from falling out of the window, to the don’t eat raw or undercooked food warnings on restaurant menus and food packaging.
We should have a contest and see how many different warnings we can all recognize in modern American society.
Again, it’s time to let raw milk drinkers be treated as adults, with opinions and beliefs they are free to hold. And I promise, I’ll give the same credence and courtesy, in return, to the very next epidemiological report that I read, so long as it doesn’t "scientifically" conclude that my freedom to eat what I want should be abridged.
It would appear from the report, all of the above and more: culture, PCR, DNA sequencing, and "PFGE" (a food safety method of DNA fingerprinting).
Could you explain a bit more about the relationship between the smoking example, causality, and how that relates to the outbreak discussion? For example, there are many laboratory studies showing that Campylobacter, E. coli O157:H7, Salmonella, etc. "cause" illness. Some of these studies even involved "feeding" humans the bacteria in different doses, and following their illnesses (and how much bacteria made them get sick). Clearly, a foodborne illness outbreak investigation is not about proving that the bugs cause illness. On David’s "immunity" thoughts (I admit, still don’t totally understand) – if the idea is that people get sick because they don’t have "good" immune systems, how do you measure that scientifically?
Also, isnt the point of the foodborne illness outbreak investigation to find the best guess about what might have caused the illnesses, and how to prevent them in the future (if possible)? Then work with the industry or the consumer with education. Maybe SPCs, fecal coliforms, outbreaks, etc. linked to raw milk can be used as a learning tool for the farms and the consumers to improve safety (where raw milk is legal – if not legal, that is another story)?
Despite the uncertainty, the results from epidemiology and foodborne illness investigation, in general, have resulted in a cumulative body of evidence that resembles "beyond a doubt." For example, outbreak studies have suggested over time that preparing a raw commercial Thanksgiving turkey on the same cutting board as the salad might make some of the family/guests sick from bugs like Campylobacter or Salmonella.
Have a safe and happy Thanksgiving!
Its Turkey Time: Safely Prepare Your Holiday Meal
http://www.cdc.gov/features/turkeytime/
"Could you explain a bit more about the relationship between the smoking example, causality, and how that relates to the outbreak discussion? "
It was a quote from the link I posted.
"Also, isnt the point of the foodborne illness outbreak investigation to find the best guess about what might have caused the illnesses, and how to prevent them in the future (if possible)? "
I would never expect a "best guess" . The fiasco of the recent tomato "best guess" showed how flawed that is. Finding the source and tracing the "hows" / "causes" would lead to ways of prevention. If you cannot find the source, how would you expect to be accurate in preventing a repitition of the contamination? Probabilities are a poor substitute for accuracy. No one disputes that bacteria can cause illnesses.
" if the idea is that people get sick because they don’t have "good" immune systems, how do you measure that scientifically?"
Perhaps it is measured in the same manner as the studies involving religion ,meditating, nutrition, depression, environment and the immune system. Duke univ has done many studies over the years as I am sure others have.
Correct, there were pathogens in the manure from the dairy, and they matched the outbreak strain.
With the tomatoes, it took longer. Things were not clear in the beginning, and that hurt industry, and the credibility of government scientists involved. Stuff happens, but in the end, they found the genetic match in peppers…from a consumer with "leftover peppers" and at the farm in Mexico.
These are examples of the lmiitations and the power of public health investigations. They are not perfect, but in an imperfect world, the scientists offer data for consideration by other scientists, industry, the public, and the media. Everyone must digest the findings and figure out the best next steps.
"Perhaps it is measured in the same manner as the studies involving religion "
I’m not sure where religion, meditating fits into the picture.
.
Sylvia-Perhaps it is measured in the same manner as the studies involving religion ,meditating, nutrition, depression, environment and the immune system. Duke univ has done many studies over the years as I am sure others have.
Sylvia-"Perhaps it is measured in the same manner as the studies involving religion "
An Observer -I’m not sure where religion, meditating fits into the picture.
Sylvia- I reposted so you could see the whole statement I responded with.
The illness time line was interesting. You would expect the raw milk illnesses to be distributed across the data collection period if they were not associated with one another. The fact that they were clustered adds weight to the linkage. Certainly it’s possible they all had another exposure in common, but they were also geographically diverse, making this less likely. Furthermore, the outbreak strain (or "an" outbreak strain since they didn’t have complete data) was found in the milk-producing cows at the dairy.
Amanda
1.Both children, siblings, developed a fever and bloody diarrhea, but only one stool specimen yielded Campylobacter. This means it is sometimes difficult to get a positive stool culture even if the pathogen was present.
2.It took six and seven days to run a culture for Campylobacter. It wasnt done immediately. It doesnt state that the children were hospitalized. After a week of symptoms, the doctor must have decided it was time to investigate the cause.
3.The same products in the alleged 2006 OP outbreak were involved–raw milk and colostrum. Not just one or the other, but both.
4.Once again, children were the victims.
The report states: Only one patient isolate was available for DNA fingerprinting; the pulsed-field gel electrophoresis patterns of isolates from FOUR cattle fecal samples collected at Dairy A were indistinguishable form the patient isolate.
This does mean that one child did get ill from contaminated raw milk or raw colostrum purchased from dairy A? Am I interpreting this correctly?
cp
There is a big difference between the work in the campy report and "unorganized" raw milk testimonials. It’s too bad that’s the case because we might be able to learn a great deal about raw milk if it were actually studied. Take the link between raw milk consumption and asthma reduction (one that would struggle through Human Subjects if it ever made it through). It would be interesting to examine changes in asthma sufferers with a smart design that would allow you to examine not simply whether someone’s symptoms improved but whether they improved in the way your theory suggests. Perhaps there are specific body changes that raw milk would bring on that would be associated with reduced asthma symptoms and not associated with many other factors that might also cause someone’s symptoms to let up (seasons? indoor air changes?). You would want to test for those changes in your sample. You would want to bring people into the study who weren’t drinking raw milk for comparison (much like the state report does with its 76 people). You could compare their changes in symptoms to the raw milk drinker changes (better vs worse symptoms in general and also more specific hypotheses that follow from the theory. I’m just spouting off in the middle of the night, but there’s a lot that could be done if you had a theory and someone seeking tenure.
What the raw milk field seems to be lacking is all of the foundational work that campy researchers have. Campy researchers at least know what campy is and what it does. They know something about food production environments associated with it. They know the typical vehicles of illness and they can tap data sources when a bunch of people get sick. They can integrate all of this knowledge into their studies to help them "organize" their observations. Testimonials make no attempt to do so.
Perhaps there is a researcher out there with enough information on raw milk and asthma who could create a theory and test it even if they did not use controlled clinical trials. Some of the best studies come out of limited data situations because they require more design creativity.
All that said, I agree with Steve that we should be able to eat whatever we want.
Amanda
"Drinking farm milk can protect children against asthma and hayfever, according to a study of nearly 15,000 children published in the May issue of Clinical and Experimental Allergy."
This study came out around 2007, I do think the study could be redone so that there are more detailed follow-ups and more controls. There are studies, they don’t appear to be as numerous as the corp sponsored studies. I noticed when surfing for information on the net, I’ll see the titles and click on the links and they are paid sites. The titles allude that there is a conncetion to asthma and nonraw dairy.
http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN97_04%2FS0007114507657900a.pdf&code=8deec2700a4200927005a5003ed21b36
Lets continue using asthma as an example. Researchers interview parents of children or adults whose asthma has improved after using raw milk. How has the asthma improved? What were the symptoms before using raw milk? What are the symptoms now? Do they still need to use medication? If yes, has it been reduced? How much raw milk is consumed to obtain the positive results?
All of the data gathered could then be put into numbers and turned into percentiles. For example, since drinking raw milk, 75% of the participants no longer need to take asthma medication.
This would not be an expensive study to conduct. Participants would be easy to find if the study was advertized throughout the raw milk community network. Phone interviews could gather all the needed information.
cp
Clarification on the campylobacter illnesses: the report says that all 8 cases were confirmed with positive cultures, but the bacteria from 7 stools were thrown away by their doctor’s laboratories (health care/private labs are not required to save campylobacter isolates), so the state was not able to do detailed DNA fingerprinting on these strains.
On the study discussion….seems the topic is researchable, but in the US there is likely to be significant resistance by the medical/public health community and/or funding agencies and human subjects (as Amanda noted) boards because of the known pathogen risks with consumption of raw milk, and the strong message against consumption by FDA and CDC. This link has a relatively comprehensive review of studies on asthma/raw milk in Europe:
http://tinyurl.com/666wqf
Also, in the 2007 Waser report on asthma that is frequently cited by raw milk proponents, this is what the authors conclude.
In conclusion
-Dietary interventions are an attractive means for primary prevention. However, raw milk may contain pathogens…therefore imply serious health risks.
-A deepened understanding of the relevant protective components of farm milk and a better insight into the biological mechanisms underlying the reported epidemiological observation are warranted as a basis for the development of a safe product for prevention.
-At this stage, consumption of raw farm milk cannot be recommended as a preventive measure.
IMHO, what they are saying is that more research is needed to "develop" a safe product by finding the "protective component" in raw milk – based on their statements, I doubt this research is leading toward a recommendation of consuming raw milk in its natural state (even with more data)…
An Observer’s point about human subjects review is a big barrier and one that the outbreak report obviously doesn’t have to deal with since it is the illnesses that trigger participation in the study. There doesn’t appear to be anything invasive except the survey itself. The stool samples are theoretically already collected.
In other news, don’t count on out-of-state milk shipments:
http://www.fresnobee.com/business/story/1027765.html
http://www.examiner.com/a-1704830~FDA_cracks_down_on_Calif__raw_milk_supplier.html
"As far as OPDC having on going illness or pathogen problem, I am completely confused as to what is being referred to? Discounting the September 2006 incident, there have been no other alleged illnesses."
Still confused?
As far as OPDC having on going illness or pathogen problem, I am completely confused as to what is being referred to? Discounting the September 2006 incident, there have been no other alleged illnesses. So. there are no ongoing illnesses at OPDC. As far as pathogens found in our raw milk.show me one that has ever been found??!! Yes the state found some campylobacter in raw cream after eight days of specialized testing in their labsbut the milk that the cream was taken from was negative. There were no illnesses related to this test or the production time period.
Sometimes Mark appears to have mental blocks or maybe it is denial. Mark, if you confused, please read the March 27, 2008 California Department of Public Heath report regarding your dairy and Campylobacter infections.
It seems that they found campy in some of your cows in 2007 as well as E.coli 0157:H7 in 2006. Grass fed cows do produce pathogens. I think it is time to amend some inaccurate statements on your website.
cp
Amanda, I googled the subject, most of what pops up is old news, Marler had his take on this topic :
"McAfee admitted as much in a 2005 Portland Tribune article in which he was quoted as saying, "And there is no regulation that you can’t eat pet food, either," according to the complaint."
I’ve had patients that ate pet food. It may be consumed more than what is realized.
[Federal law mandates that raw milk in final package form intended for human consumption cannot be transported across state lines. To do so would constitute a violation of federal law CFR 1240.61.
Non-California customers may not order our raw milk, however, they do have the option of ordering Superlite Colostrum, which is appx. 95% raw milk and 5% colostrum.
Superlite Colostrum is classified by the FDA and the California Department of Health as a non-dairy dietary supplement" because it contains small amounts of colostrum.]
http://www.capitalpress.info/main.asp?SectionID=94&SubSectionID=801&ArticleID=46454&TM=40957.18
That is the article Marler cites. The quote you list, Sylvia, is from there, not from Marler.
I know poor folk who have eaten cat food/tuna wherein the cat food is regulated and sold as pet food. I guess the question is whether this liquid pet food was sold as food for Fido or for people.
Initial article:
http://www.portlandtribune.com/news/story.php?story_id=33254
McAfee letter:
http://www.portlandtribune.com/opinion/story.php?story_id=33431
From the letter:
"By denying Oregonians a safe alternative and the ability to access Organic Pastures raw milk as a pet food, raw milk consumers will have to go back underground to drink from untested dairies. …
People can eat cat food if they want to, especially when it does not make them sick and people food does make them sick. It makes you really wonder if our government is interested in our immune health or our immune destruction."
This is an older article found.
http://www.nytimes.com/2007/08/08/dining/08raw.html
In 2000, the Organic Pastures Dairy Company in the San Joaquin Valley near Fresno became Californias first raw milk dairy with certified organic pasture land. This year its co-founder, Mark McAfee, expects it to gross $6 million up from $4.9 last year.
His raw milk is sold in 300 stores in California, where it is legal. He also has an $80,000 a month mail order business, shipping creams and cheese as well as milk to all 50 states. He believes he reaches 35,000 customers a week for his raw milk products. Because the laws allow interstate shipping of raw milk that is not meant for human consumption, Organic Pastures milk is labeled as pet food.
I like to go into the warehouse and see the addresses it goes all over creation, he said. We dont have the same customers day in and day out. Were the entry point. We hear back that shipping is too expensive but that they found a local provider, either a farm or on the black market. They have got to have it.