In August 2006, Ruby Trautz of Omaha, Nebraska was the first person of several to die in a foodborne outbreak after eating uncooked baby spinach laced with E. coli 0157:H7, a pathogen that makes a deadly toxin not unlike the infamous poison ricin. Not that Trautz’s doctors knew it at the time. The truth is, when the lively 81-year old first passed bloody stool, then became uremic and seized, her doctors assumed (despite her negative test) that Trautz had a terrible case of colitis due to C. difficile.
Soon after Trautz expired, however, her son-in-law Ken Costello also suffered diarrhea and agonizing abdominal pain. His doctor diagnosed diverticulitis.
Finally, in mid-September, the multi-state outbreak linked to bagged, pre-washed Dole-brand spinach packed by California’s Natural Selection Foods made national headlines. When Costello and his wife learned this news, they quickly returned to the home they had previously shared with Trautz. Sure enough, still in the fridge was an open package of spinach eaten by the entire family that was later sent to a lab where a slurry was cultured. That specimen grew the outbreak strain.
The final toll of illness for 225 infected people residing in 27 states? Although there were only five confirmed deaths, more than half were hospitalized, and 39 suffered life-threatening hemolytic-uremic syndrome.
This leafy-green fiasco was just another milestone in the story of a hazardous microbe that still thrives in many U.S. livestock. Thirteen years earlier, after surfacing in undercooked Jack in the Box hamburgers, the same toxic bug launched the career of a leading plaintiffs’ attorney featured in a new Netflix documentary called “Poisoned: The Dirty Truth About Our Food.”
Not only has “Poisoned” won kudos for its frank depiction of a “broken system that often places profit over public health,” the film has much to teach doctors about growing threats along American farm-to-fork chains plus modern loopholes and legislative inertia surrounding the safety of American food.
The Story of Bill Marler
In the world of foodborne illness and food safety, Seattle attorney Bill Marler, JD, is a hero to many people. For more about his one-of-a-kind passion and style, take a look at a 2015 story in The New Yorker that covers his present-day campaign against Salmonella. But back in 1993, when Jack in the Box fare started to sicken and kill, Marler had not yet found his calling.
Then came an SOS about 9-year-old Brianne Kiner, a desperately ill child who had already spent 40 days in a coma and 5 months in a hospital connected to wires and tubes. “She was just so vulnerable, and she just ate a fricking hamburger,” was Marler’s characteristic comment in “Poisoned.”
After meeting Brianne and forcing back tears, the 35-year-old lawyer then went to work, ultimately winning the largest personal injury pay-out ($15.6 million) awarded in his state to date. It wouldn’t restore her health, but at least it would cover care for the rest of Brianne’s life.
For Marler, lawsuit upon lawsuit then followed, some stemming from further outbreaks of E. coli 0157, others involving different foodborne perps such as Salmonella, Campylobacter, hepatitis A, and Listeria. But perhaps Marler’s proudest (non-monetary) 1990s win came when Michael Taylor, JD, then a senior lawyer at the U.S. Department of Agriculture (USDA), announced that raw ground beef contaminated with E. coli 0157 would henceforth be deemed “adulterated.”
The industry reforms that followed now mean that eating a fast-food hamburger in the U.S. poses only a fraction of the risk of fresh produce, as shown by the outbreak that killed Trautz.
“Poisoned” advances this theme by educating viewers about the proximity of massive cattle feedlots and agricultural lands in Yuma, Arizona, and California’s Central Valley, a modern recipe for disaster that periodically allows animal feces to enter irrigation canals and contaminate downstream crops like romaine lettuce. Or the blatant disregard for crowding of animals and on-site sanitation in other factory farms that fuels Salmonella-laced filth that can ultimately taint poultry and eggs.
Egregious violations have even prompted criminal prosecution. The most dramatic example? The 28-year prison sentence meted out to Stewart Parnell, former CEO of the Peanut Corporation of America, after Parnell repeatedly instructed certain employees to cover up positive Salmonella tests in 2008 to 2009. The final outcome of this wanton falsification was a multistate outbreak of Salmonella typhimurium that killed at least nine people and sickened many hundreds more who consumed a slew of peanut-containing items sold in 46 states.
A Medical Call to Action
What is more relatable than food? After all, everyone eats, and everyone occasionally suffers a foodborne illness. However, some U.S. doctors tend to discount foodborne illnesses because — despite our food supply’s many imperfections — Americans suffer fewer such incidents and related deaths than residents of most other countries. Oft-cited statistics from a seminal CDC study published in 2011 concluded that, at that time, one in six Americans — roughly 48 million people — suffered a foodborne illness each year, 128,000 were hospitalized, and 3,000 died.
These data stand in stark contrast to a WHO study published in 2015. In their first-ever analysis of the global burden of foodborne disease, the authors assessed 31 individual “hazards” and reached a final estimate of 420,000 foodborne illness deaths per year — 40% in children under 5. Not surprisingly, the study listed some risks most U.S. doctors and medical students rarely if ever consider. For example, hepatotoxic aflatoxins contaminating moldy grain, or cysticercosis — larval infection with pork tapeworm — which underlies many cases of epilepsy in low- and middle-income countries.
At the same time, a universal risk both here and abroad, is non-typhoid Salmonella, which consistently ranks as the top cause of foodborne death worldwide.
My concern is that foodborne diseases and food safety are rarely covered in medical school curricula and that even seasoned MDs often lack knowledge about changing trends, contributory factors, and the messy web of government agencies and regulations (don’t get me started about the weird jurisdictions and different mindsets of the USDA and the FDA). The list goes on.
Weaving case studies involving real people, outbreaks, and regulatory policies into continuing medical education would be one way to start (for example, do most readers even know their state’s stance on the legal sale of unpasteurized milk?). Having medical students watch “Poisoned” is another.
At the end of the day, why shouldn’t doctors and other healthcare professionals join the ranks of lobbyists, advocates, and educators around ongoing farm-to-fork reform? After all, the microbes aren’t going away anytime soon, they’re only traveling farther (and becoming more antibiotic-resistant) as our food supply grows ever more global.
Claire Panosian Dunavan, MD, is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Tropical Medicine and Hygiene. You can read more of her writing in the “Of Parasites and Plagues” column.
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