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Originally published October 29, 2011 at 10:00 PM | Page modified October 30, 2011 at 9:14 AM

What you eat can kill you if you don't watch out

Tainted food is everywhere, and if you think you're being thoroughly protected, think again.

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WE'LL START with a question: Do you care what you put in your mouth? Because if you do, you should have noticed a few things over the summer.

1. On Aug. 3, 36 million pounds of ground turkey were recalled. That's enough to make two burgers for every American child. The turkey was linked to 119 salmonella illnesses and one death.

2. On Aug. 11, strawberries sold at Oregon farmstands were recalled after the berries, described as "gorgeous," were linked with 14 illnesses and one death. E. coli O157:H7 was the culprit in that one.

Two kinds of food — meat and fruit. One produced by the biggest private company in the U.S., the other by fourth-generation farmers and sold at farmers markets. Two ends of the spectrum with the same problem — foodborne pathogens.

We started out asking, "Do you care?" for a reason. That's because a lot of people seem to gloss right over reports like these. The ground-turkey case was one of the largest meat recalls in history. Yet, my editor confessed she didn't even check the turkey in her freezer against the recalled batches. Meanwhile, my favorite NPR food personality, Lynne Rossetto Kasper, decided to make turkey burgers her recipe of the week, recommending the meat to thousands of email subscribers. Not only did she seem blind to the biggest news in food-dom, but the temperature she told subscribers to cook the burgers to wouldn't kill pathogens.

And me? I don't even use a meat thermometer, despite writing about food safety for several years.

So, back to the initial question. Do you care what you put in your mouth?

Well, of course, you'd probably say.

But I'm willing to bet you haven't got much of a clue.

For starters ...

That ground turkey? Numerous samples tested positive for salmonella at the plant, yet it went out to your grocer's meat case anyway. Perfectly legal, by the way.

Fresh fruits and vegetables? Pathogens on them make tens of thousands of Americans sick every year. And their problems are even harder to solve than those found in meat.

At this point, we would be remiss if we didn't point out that many safety provisions do protect us from contaminated food, and that people and events here in Washington are the main reason we have them at all.

Still, we want to get one point across: What you don't know really can kill you.

In the beginning, there was Jack

Darin and Vicki Detwiler don't cry when they tell you their son, Riley, was hospitalized just days after taking his first few steps, and that he never recovered. They don't want the sadness to overwhelm their point.

Technically, their story is about Jack in the Box. About how an undercooked burger led to Riley's death in 1993. But really, it's much larger than that. It's about the food-safety system in America — how it's changed because of cases like Riley's. And how it hasn't.

Charles Easterberg, who teaches a food-safety course at the University of Washington, calls the Jack in the Box outbreak 18 years ago the "Pearl Harbor for the food game."

Three Washington children, dead. More than 500 people here sickened. Seattle Children's hospital was "like a war zone," says food-safety lawyer Bill Marler. They had to fly in extra dialysis machines for all the kidney-failure cases, he says.

The cause was E. coli O157:H7.

National television followed the story of Brianne Kiner, a Redmond girl who spent her 10th birthday in the hospital during a harrowing five-month stay. Strangers prayed for her recovery as she lay comatose for 40 days. Miraculously, she survived, but with lifelong problems.

Brianne may not have made it if she lived elsewhere. It just so happened that doctors here knew more than most about identifying E. coli and treating it.

Our state epidemiologist also deserves much of the credit for stemming the epidemic.

John Kobayashi didn't have all the proof that would be expected in a case like this today — DNA tests unequivocally linking the E. coli strain in the meat to that in the people. Back then, tests like that took months. But he had enough experience to know time was of the essence. He decided to name names. Initially, Jack resisted, but later realized the science was right.

Hundreds of thousands of patties from the same tainted batch were sitting in company freezers; researchers estimate another 800 people would have been sickened if they had been served.

Dan Rather, Tom Brokaw, Peter Jennings, they all reported on the outbreak.

"If I would have been on TV in 1992 saying hamburger can kill you, I would have been called a nut," says Dr. Phillip Tarr, the gastroenterologist who treated many of the Children's patients. "In February of 1993 I said that, and I was called a hero."

As for the Detwilers, after Riley's death, President Clinton called with his condolences. The family received cards from people all over the country.

"People did put our face on it," Vicki says. "They saw it could happen to ordinary people."

Even people who never set foot in Jack in the Box.

That's right: Riley was infected without eating a tainted burger.

But aren't things different today?

When Riley died, the laws that governed most food inspections hadn't changed much since Teddy Roosevelt affixed his signature to them.

After Jack in the Box, everything changed.

Well, technically, everything didn't change. In fact, there's a lot about modern food-safety laws that isn't exactly modern. We'll get to that in a minute. But for now, suffice it to say that Brianne and Riley and all the rest had a big effect. For a time anyway.

The beef industry was shaken to its core. The USDA went through a profound philosophical shift. The science behind a lot of this changed, too, as researchers across many disciplines — agriculture, veterinary medicine, epidemiology, biology — scrambled to learn more.

First the USDA.

Back then, they said pathogens weren't their problem. You want to be sure about your meat? Cook it, they said.

After Jack in the Box, that argument became less tenable. Not when parents like the Detwilers were appearing on national TV and filing lawsuits.

The law itself would be hard to change, though. Instead, the USDA decided to look at the old law in a new way.

Bear with us here. We realize that the reinterpretation of an obscure law isn't exactly scintillating news. But this is important — akin, says longtime food-safety advocate Carol Tucker-Foreman, to "deciding the Earth is not flat."

The law has always said it was illegal to sell meat with harmful "adulterants." But foodborne pathogens — even the stupendously toxic E. coli O157:H7 — weren't considered adulterants. Inspectors weren't even checking for these bugs.

Basically, meat inspectors looked at the animals. Did they appear sick? They sniffed the carcasses, checked if they felt normal to the touch. Then they stamped the meat with the government seal. Approved by the U.S. of A.

But in 1994, the USDA announced that E. coli O157:H7 constitutes an "adulterant." Inspectors began testing samples for it.

Industry bigshots went to court to fight the new rules, which many saw as radical. They lost.

Then the USDA went even further. It made more rules requiring production facilities to reduce the chance of toxic substances entering the food supply. Those methods would have to be based on — gasp! — science. The industry argued that this, too, was radical, maybe even impossible.

It's called Hazard Analysis and Critical Control Points — HACCP (say "hassip") for short. In essence, producers would have to identify each step in the process where pathogens might lurk. For instance, manure on cow hides is a big problem, because that's where E. coli and other bugs live. Under HACCP, companies would have to take steps to reduce the chance of that manure getting ground up in your burger.

In recent years, some retailers and restaurants have also stepped up. Costco, for example, has controls covering everything from testing at the farm to stocking on the shelves. Restaurants like Jack in the Box do the same by using highly calibrated grills to ensure food is cooked to pathogen-killing temperatures.

The new rules have had an effect on E. coli O157:H7. Cases of the illness appear to be on the decline, according to the Centers for Disease Control.

In fact, Tarr, the Children's doctor, believes you can pretty much be sure the burger you get at a fast-food chain today is E. coli-free.

That's a relief.

But it turns out that addresses only one iota of the problem.

How about some salmonella with your chicken?

There's a funny thing about declaring E. coli O157:H7 an adulterant, says Marler, the lawyer.

"It means the opposite is true for everything else."

Take last summer's ground-turkey fiasco.

In August, Cargill recalled batches produced at a certain plant over the previous six months.

Later, we learned that back in April, authorities had already begun to suspect the turkey was behind a number of illnesses. That was disturbing enough. Then came an even bigger bombshell:

Two government agencies knew the turkey contained salmonella, yet they allowed its sale anyway.

Four times between April and July, the CDC had found the strain of salmonella in packages it bought at grocery stores as part of a routine program testing for antibiotic-resistant pathogens. (Yes, this strain is resistant to a number of them.)

Even before that, USDA inspectors had found the strain of salmonella in tests of Cargill's ground turkey all the way back on the production line. Yet that ground turkey still made its way to grocery cases.

Turns out it's not illegal to sell raw meat that tests positive for salmonella. Ditto for the pathogens campylobacter and listeria. They're not considered "adulterants" in raw meat and poultry. Yet these bugs sicken thousands — and can kill, too.

"As citizens, we should be angry," says Tucker-Foreman, the food-safety advocate.

Actually, government and industry concede that they expect to find poisonous bugs in our food. Tests have consistently found that about two-thirds of chicken carcasses, for example, are contaminated with some type of pathogen.

"People think if they buy reputable food, it's going to be safe," explains J. Kathryn MacDonald, a state epidemiologist. "That whole concept is off the mark. If you're eating food that is from an animal or is grown in dirt — which are some of our most nutritious foods — they're not sterile."

But if positive salmonella tests don't force a company to take food off the market, what does?

Marler is glib. "Bodies," he says. He means numbers of people who get sick or die, and whose illness can be inarguably tied, via DNA, to the tainted food.

Cases like Ruby Jane Lee's. The Oregon girl, just 10 months old, developed diarrhea last June, using as many as 20 diapers a day. Her fever spiked to 102.5 and she wasn't getting better. Finally, a doctor figured out she had salmonella poisoning, according to a lawsuit Marler filed on behalf of the family. The pathogen had gotten into her bloodstream. She was rushed to the hospital, her parents terrified. Ruby Lee survived.

It still boggles the mind that she spent a week in the hospital because of a turkey meatball.

But I'm vegetarian. I don't need to worry

For years, the problem seemed to center on burgers.

"Now," says Marler, "it's any food."

Refrigerated cookie dough. Peanut butter crackers. Cantaloupes. Strawberries.

These are all products regulated by the Food and Drug Administration. (The USDA is in charge of meat and poultry; with few exceptions, the FDA does all the rest.) And that agency has its own problems.

Epidemiologist Kobayashi remembers coming back from a long consulting stint in Japan and hearing about the 2006 spinach outbreak (238 sick, five dead). "It was a sense of déjà vu all over again," he says. "We had been talking about this for 10 years. I thought, what in the world is going on?"

Despite all they'd learned from Jack in the Box, gaps were everywhere.

When snacks made with tainted peanut butter were linked with an estimated 20,000 illnesses and nine deaths in 2009, we learned the Peanut Corporation of America plant operated with a leaky roof, rodents — and repeated positive salmonella tests.

Federal auditors have been saying for at least three decades that the food-safety system is broken.

When the spinach case broke,the industry and the agency had been actively debating safe-production guidelines for about a decade.

It turns out produce is a particularly vexing problem. With meat and poultry, there's usually a built-in "kill step." If you cook it all the way through (which is much more technical than it sounds), pathogens die. Fruits and vegetables, however, are often eaten raw. There is no kill step.

Take those Oregon strawberries. Authorities now believe that deer regularly traipsed through the fields and that their manure — and the E. coli in their intestines — got on the berries. It's tough to wash bacteria from a strawberry's dimpled surface. (Ditto for cantaloupe, raspberries, sprouts and many other things.)

Dr. Tarr says the last thing he wants to do is discourage people from eating produce. Nonetheless, he isn't optimistic about solving the problem. "You can't make fresh fruits and vegetables safe."

Year after year since Jack in the Box, scientists, families and consumer groups have demanded changes. Finally, last December, Congress passed the Food Safety Modernization Act, which will require farmers and producers regulated by the FDA to incorporate HACCP-like safety controls. The agency also will have the power to force recalls.

It'll take years before all this gets going. In the meantime, wash the heck out of your produce. Or cook it.

"I shouldn't have to treat food that comes into my house as though it were toxic," Tucker-Foreman says.

No, she shouldn't. But she does.

C'mon. This can't possibly happen to me

If you've made it this far, bravo. The Detwilers would be happy to know you're paying attention.

After Riley's death, they had a mission: "Make E. coli a household name," Darin explains. Between the two of them, they've testified before Congress, spoken at meat-industry conferences, and appeared on national TV. They've learned so much.

The craziest thing about their case is that Riley didn't even eat at Jack in the Box in the first place. He got sick from contact with another kid at day care. That boy's family had taken him to a Jack in the Box in Bellingham, despite the news that people were getting sick in the Seattle area.

"They chose to feed their own child undercooked hamburger," Vicki says. The boy developed diarrhea and he visited a doctor. As they waited for test results, he went back to day care. With Riley.

Those parents, of course, didn't think it could happen to their kid. And technically, it didn't. That boy was better in a few days.

"Other people's ignorance resulted in our child's death," Vicki says flatly.

That ignorance remains.

A few years ago, she appeared on a televised town hall meeting with the mother of another child who had recently died from foodborne illness.

"She said she thought the problem was fixed because there was that outbreak years ago," Vicki recalls. "She didn't think it applied to her."

The lesson, she says, is "you can't expect the head of some corporation in Pennsylvania or someplace to watch out for what your child is eating." You've got to do it yourself.

Vicki says she's grown frustrated.

"We're old news. The only thing that brings that information back to the fore is when someone else gets sick."

She thought about it for a moment.

"You need some young mother, a young face, in your story."

But that would mean another child had died.

Maureen O'Hagan is a Pacific Northwest magazine writer. Benjamin Benschneider is a Pacific Northwest magazine staff photographer.

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