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For nearly two decades, Public Enemy No. 1 for the food industry and its government regulators has been a virulent strain of E. coli bacteria that has killed hundreds of people, sickened thousands and prompted the recall of millions of pounds of hamburger, spinach and other foods.

But as everyone focused on controlling that particular bacterium, known as E. coli O157:H7, the six rarer strains of toxic E. coli were largely ignored.

Collectively, those other strains are now emerging as a serious threat to food safety. In April, romaine lettuce tainted with one of them sickened at least 26 people in five states, including three teenagers who suffered kidney failure.

Although the federal government and the beef and produce industries have known about the risk posed by these other dangerous bacteria for years, regulators have taken few concrete steps to directly address it or even measure the scope of the problem.

For three years, the United States Department of Agriculture has been considering whether to make it illegal to sell ground beef tainted with the six lesser-known E. coli strains, which would give them the same outlaw status as their more famous cousin. The meat industry has resisted the idea, arguing that it takes other steps to keep E. coli out of the beef supply and that no outbreak involving the rarer strains has been definitively tied to beef.

The severity of the April outbreak is spurring a reassessment.

“This is something that we really have to look at,” said Senator Kirsten Gillibrand, Democrat of New York, who plans to introduce a bill that would pre-empt the Agriculture Department by declaring a broad range of disease-causing E. coli to be illegal in ground beef and requiring the meat industry to begin testing for the microbes. “How many people do we have to see die or become seriously ill because of food poisoning?”

The issue will be one of the first faced by President Obama’s nominee to head the department’s food safety division, Dr. Elisabeth Hagen, who is scheduled to testify Thursday in her Senate confirmation hearing.

Part of the problem is that so little is known about the rarer E. coli strains, which have been called the “big six” by public health experts. (The term refers to the fact that, after the O157 strain, these six strains are the most virulent of a group of related E. coli.) Few food companies test their products for the six strains, many doctors do not look for them and only about 5 percent of medical labs are equipped to diagnose them in sick patients.

A physiological quirk of E. coli O157 makes it easy to test for in the lab, and many types of food are screened for it. The other E. coli strains are much harder to identify and testing can be time-consuming. The Agriculture Department has been working to develop tests that could be used in meat plants to rapidly detect the pathogens.

The lettuce linked to the April outbreak tested negative for the more famous form of E. coli, but no one checked it for the other strains, according to the Ohio company that processed it, Freshway Foods. It turned out that the romaine was infected with E. coli O145, one of the more potent of the six strains.

Emily Grabowski, 18, a student from Irondequoit, N.Y., ate some of the lettuce at her college dining hall and ended up in the hospital with kidney failure. Recuperating at home, she wonders now if she could have been spared her ordeal. “If they had tested it and they had caught it,” she said, “I wouldn’t have had the E. coli.”

Earthbound Farm, the nation’s largest producer of organic salad greens, is one of the few companies that does screen for the full range of toxic E. coli, and it has found a worrisome incidence of the rarer strains. Out of 120,000 microbial tests last year, about one in 1,000 showed the presence of unwanted microbes, mostly the six strains.

“No one is looking for non-O157 to the level we are,” said Will Daniels, Earthbound Farm’s senior vice president for food safety. “I believe it is really going to emerge as one of the areas of concern.”

Earthbound Farm was not involved in the April outbreak.

The O157 strain of E. coli is a frightening bug, causing bloody diarrhea and sometimes kidney failure, which can be fatal. Some of the six strains cause less severe illness, but others appear to be just as devastating as the O157.

The toxic E. coli bacteria originate in the guts of cattle, putting the beef industry on the front line. The O157 strain achieved notoriety in 1993 when four children died and hundreds of people were sickened by tainted hamburger sold at Jack in the Box restaurants. The next year, the Agriculture Department made it illegal to sell ground beef containing the O157 bacteria.

The beef industry now routinely tests for the O157 strain, but there is no regular testing for the other six strains.

It is unclear how prevalent the six strains are in ground beef. Preliminary data from a department study found the pathogens in only 0.2 percent of samples. By comparison, the O157 strain already banned shows up in about 0.3 percent of samples, according to other government data.

But tests commissioned by William Marler, a Seattle lawyer who represents victims of food poisoning and has pushed the department to ban more E. coli strains, found the six strains in 0.7 percent of ground beef samples bought at supermarkets.

The E. coli bacteria can be killed by thorough cooking to 160 degrees.

Tracking the impact of the rarer E. coli strains on human health is difficult because few medical labs test for them, and health officials say illnesses caused by them are vastly underreported.

Data from the Centers for Disease Control and Prevention showed at least 10 food-borne outbreaks from 1990 to 2008 involving the six strains, carried in foods like salad or strawberries. Investigators suspected ground beef as the cause of a 2007 outbreak in North Dakota, but the link was not confirmed.

The April outbreak is a signal of a broader problem, said Michael R. Taylor, deputy commissioner for foods at the Food and Drug Administration.

“We need to be developing our tools and abilities to assess” the full range of toxic E. coli, he said. The agency, which regulates produce, is waiting for Congress to pass a law that would greatly expand its food safety authority.

It is not clear how E. coli travels from cattle to produce, but scientists think it may occur through contact with manure, perhaps tracked through fields by wild animals, or through tainted irrigation water.

For its part, the Agriculture Department has said it is reluctant to ban the broader range of E. coli in beef until it has developed tests that can rapidly detect the pathogens. It expects to complete those by the end of 2011 and then study how often the six strains show up in the beef supply.

But an official said the timetable was not rigid. “I don’t want to give the impression that we’re going to wait months and months for these tests, and months and months to see what’s in the beef supply,” said Dr. David Goldman, an assistant administrator for the Office of Public Health Science of the department. “In terms of policy options, it’s not like we have to do one and then the other.”

James H. Hodges, executive vice president of the American Meat Institute, an industry group, said that the industry had put in place many procedures to keep E. coli O157:H7 out of ground beef, like washing carcasses in hot water and lactic acid.

Those steps also work against the other E. coli, Mr. Hodges said, pointing to the lack of outbreaks of illness connected to them. “It certainly tells me that both the government and the industry is targeting the correct organism,” he said.

Dr. Richard Raymond, who was the department’s head of food safety from 2005 to 2008, said he stopped short of banning the rarer E. coli from hamburger because he thought that he would not have been able to defend the decision against industry criticism until rapid tests were developed.

But he said the April outbreak could push regulators to act. “I don’t think the U.S.D.A. wants to see another Jack in the Box,” Dr. Raymond said.

In E. Coli Fight, Some Strains Are Largely Ignored,
NYT,
26.5.2010,
http://www.nytimes.com/2010/05/27/business/27bugs.html

Letters

Putting America on a Healthier Diet

September 12, 2009

The New York Times

To the Editor:

Re “Big Food vs. Big Insurance,” by Michael Pollan (Op-Ed, Sept. 10):

Mr. Pollan rightly contends that health care reform will be ineffective unless the country’s increasing obesity problem is addressed. But because the food industry is only part of the problem, reforming it is only part of the solution.

The other part of the problem is the American consumer. While food producers provide an array of unhealthy fare, how, what and when we eat are personal choices.

Mr. Pollan praises attempts to tax sugary sodas because these products add empty calories to our diets, particularly for our youth. Yet sugar-free sodas have been available and widely consumed for 40 years. The choice is the consumer’s.

If we are to make headway on this issue, we must have comprehensive physical education and health education in our schools and incentives supporting healthy, active lifestyles and nutritional food choices for all citizens.

Like all industries, the food producers are driven by their bottom line. Only when consumers begin to demand healthier food will the industry change.

Anne-Marie Hislop
Davenport, Iowa, Sept. 10, 2009

•

To the Editor:

I applaud Michael Pollan’s recognition that obesity is the “elephant in the room” in the health care debate, but dissent on his solutions.

Taxing specific products such as soft drinks or creating yet another educational program will not get the job done. Multiple studies have demonstrated that “fat” taxes will not appreciably lower obesity rates, while attempts to change consumer eating behavior have historically come up short.

The real enemy is the number of excess calories available for consumption, regardless of the source. The only way to slim down this beast is to engage the food industry.

Rather than alienate or overregulate the industry, my recommendation is to put into effect tax incentives that would entice food companies to sell fewer calories. If they cut their calories, they would be rewarded. If they continued to spew excess calories on the public, they would risk losing favorable tax treatments.

This approach is well worth discussing. Our nation’s health depends on it.

Henry J. Cardello
Chapel Hill, N.C., Sept. 10, 2009

The writer is a former food industry executive and author of “Stuffed: An Insider’s Look at Who’s (Really) Making America Fat.”

•

To the Editor:

Eating well and exercising are important, but not necessarily a panacea against disease.

I am a 55-year-old woman who is slim, eats a healthy organic diet, takes ballet classes and practices yoga on a weekly basis.

I had breast cancer in 2003 and learned I had Stage 4 tonsil cancer in 2008. My out-of-the-pocket costs for my recent treatment for tonsil cancer totaled $15,000.

As part of my follow-up care, I need thousands of dollars of dental work, plus expensive magnetic resonance imaging every six months for the next three years. My monthly health insurance premium, for me alone, has gone up to $662.

Michael Pollan is correct in targeting agribusiness for contributing to obesity, but he does a grave disservice to me, and Americans in general, when he links the dire consequences of not having strong and meaningful health care reform with the honorable, but separate, issue of food industry reform.

Francesca Pastine
San Francisco, Sept. 10, 2009

•

To the Editor:

As a big fan of Michael Pollan, I was delighted to read “Big Food vs. Big Insurance.”

I am 65, look 50, and weigh 10 pounds more than when I graduated from high school, where I lettered in two sports. I work out three or four times a week, recently added two weekly yoga classes, take stairs whenever possible and have no major health issues.

My “diet” is to eat as much as I need, and no more. If my weight is up a little any morning, I just eat less that day.

My wife and I usually split the massive entrees at restaurants, we eat very little meat, and our snacks are fruits and nuts. And yes, I indulge — with a little delicious dark chocolate and low-fat ice cream every day.

I don’t eat junk food or buy the soft drinks and other reconstituted muck that American agribusiness currently substitutes for real food.

When Americans demand that restaurants and agribusiness put our health first, I will no longer be unusual.

James G. Goodale
Houston, Sept. 10, 2009

•

To the Editor:

Michael Pollan’s essay on the role of the food industry in contributing to obesity and associated chronic diseases may have some merit, but only because too many consumers make poor dietary choices, meal after meal, day after day.

Are we really going to blame the food industry for providing foods we enjoy but overindulge in? When did personal responsibility go out the window?

Most of us like a good hamburger with all the “fixings,” maybe even fries and a shake with it. But is the provider to blame when we consume them day after day, and couple this with other food choices that are high in calories and fat, with little or no exercise to offset these poor dietary choices?

The old saying that there are no good foods or bad foods, only good or bad diets, is still relevant.

Rather than play the blame game, we should direct our efforts at better educating consumers on the importance of balancing caloric intake with energy output.

Taxing or blaming the food industry may add more money to the government coffers, and make some feel better, but it has no public benefit.

James Stanley
Jasper, Ga., Sept. 10, 2009

Putting America on a Healthier Diet,
NYT,
12.9.2009,
http://www.nytimes.com/2009/09/12/opinion/l12pollan.html

Op-Ed Contributor

Big Food vs. Big Insurance

September 10, 2009

The New York Times

By MICHAEL POLLAN

Berkeley, Calif.

TO listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.

The American way of eating has become the elephant in the room in the debate over health care. The president has made a few notable allusions to it, and, by planting her vegetable garden on the South Lawn, Michelle Obama has tried to focus our attention on it. Just last month, Mr. Obama talked about putting a farmers’ market in front of the White House, and building new distribution networks to connect local farmers to public schools so that student lunches might offer more fresh produce and fewer Tater Tots. He’s even floated the idea of taxing soda.

But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.

Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side — like the large segment of the Fortune 500 that has concluded the current system is unsustainable.

That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.

The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.

As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.

But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.

AGRIBUSINESS dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind.

In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda. At the moment, a federal campaign to discourage the consumption of sweetened soft drinks is a political nonstarter, but few things could do more to slow the rise of Type 2 diabetes among adolescents than to reduce their soda consumption, which represents 15 percent of their caloric intake.

That’s why it’s easy to imagine the industry throwing its weight behind a soda tax. School lunch reform would become its cause, too, and in time the industry would come to see that the development of regional food systems, which make fresh produce more available and reduce dependence on heavily processed food from far away, could help prevent chronic disease and reduce their costs.

Recently a team of designers from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthcare to develop an innovative systems approach to tackling childhood obesity in America. Their conclusion surprised the designers as much as their sponsor: they determined that promoting the concept of a “foodshed” — a diversified, regional food economy — could be the key to improving the American diet.

All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.

But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.

For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.