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Recommendations, Information
And Public Health

The proposal to impose federal regulation on the industry is unobjectionable to most — at least in those commodities where there is known risk. If the government regulates fresh herbs, green onions, cantaloupes, leafy greens and tomatoes… and if the regulation is effective… it will at least eliminate the issue of sub-standard operations endangering public health and harming the whole industry.

What it is not likely to do is change the way the FDA reacts when there is an outbreak. And that is a big problem.

An effective national food safety policy has to include both a plan to prevent food safety problems and a method for dealing with them when they do arise.

The FDA is wearing blinders here because they feel a need to “recommend” courses of action — don’t eat spinach, don’t eat tomatoes, don’t eat peppers — as opposed to feeling an obligation to inform.

This is a dilemma which Congress really should clarify.

The National Highway Traffic Safety Administration, for example, publishes copious information to help consumers evaluate the safety of cars. It has a web site — — that includes driving tips, advises people about defects and recalls and allows people to search for a “star rating” of safety on various attributes. Here is a sample page for SUVs.

What the NHTSA does not do is issue recommendations as to whether people should drive or not, leaving individuals to judge the risk/reward ratio of the behavior.

The FAA works diligently to protect the safety of air transportation. Way back in the spinach crisis, we ran a piece excerpted from the FAA’s website to show how it discussed safety:

The goal for the end of the fiscal year is a three-year rolling average of 0.018 fatal accidents per 100,000 departures. Through March of this year, the aviation industry has maintained a rate of 0.022 fatal accidents per 100,000 departures. There have been three fatal air carrier accidents this fiscal year… The FAA continues its work that has resulted in the almost continuous long-term reduction of the commercial air carrier fatal accident rate.

What the FAA does not do is go around issuing recommendations as to whether .018 fatal accidents per 100,000 departures is something an individual should accept or not.

A serious foodborne illness caused by fresh produce is an exceedingly rare event. This means that it is very difficult to increase an individual’s personal safety through a consumption restriction on fresh produce. Look at the numbers for this very large and serious outbreak related to Salmonella Saintpaul.

The CDC estimates that there are 76 million cases of foodborne illness in the US each year. With 1,307 known ill, and if we multiply each by 30 people to adjust for under reporting, we have an enormous outbreak of 39,210 people. Fortunately most not ill enough do not go to a hospital. Since the outbreak is still ongoing, let us assume the total illnesses will wind up being 50,000 people sick.

This is, of course, terrible, yet even an outbreak of this unprecedented scale poses little risk.

With about 305 million Americans and 76 million foodborne illnesses, there is a 24.918% chance that an American will get a foodborne illness during the course of a year. This number includes outbreaks.

So if we had perfect foresight and could have avoided this outbreak entirely, how much would Americans have benefited? Well, then the math would be that there would be 75,950,000 foodborne illnesses this year. Divided by 305 million people and the risk of getting a foodborne illness would have been reduced to 24.916% — a difference of .002%.

Of course most people take lots of risks that could cause them to get a stomach ache — eating from street vendors, etc. So they are more likely to be concerned about serious illnesses such as would require hospitalization.

The CDC currently estimates that there are 325,000 hospitalizations each year due to foodborne illnesses. Yet this enormous outbreak has generated only 253.

With 325,000 hospitalizations and 305 million people, the risk of an American being hospitalized in a year due to a foodborne illness is only .1066%, and if we knew about this Salmonella Saintpaul outbreak in advance and prevented anyone from eating these products, the risk would be 324,747 hospitalizations per year with 305 million people or .1065% risk of hospitalization — a difference of .0001%.

Now in reality these numbers substantially overstate the benefit of any public health recommendation as they assume that the government knows about the outbreak before it starts. More realistically, if the outbreak is half over before the government would identify the outbreak, determine its cause and issue a recommendation, the public health benefit of FDA recommendations would be only half the very small numbers listed above.

In America, we believe in freedom and consumers having the right to make choices for themselves.

If an FDA recommendation was just that — a suggestion — it might not pose a problem, but because virtually all reputable chains, both retail and foodservice, will not sell product that FDA recommends people not eat, an FDA recommendation not to consume functions as a de facto recall.

Because the FDA recommendation is so powerful with the trade, yet the public health benefits are so small, down to the third and fourth decimal place, FDA should avoid issuing recommendations when the impact on public health is so small.

Basically all people take risks every day and to “recommend” that consumers not eat or do something because it has an effect on risk down to the third or fourth decimal place is simply to impose a conservative risk aversion profile that may or may not be in accordance with the way individuals would elect to live their lives.

As such, FDA should abandon this policy of making these broad recommendations not to consume. Instead, as with the NHTSA, FDA should publicize what information it has, being careful, of course, to put it in perspective.

There are two separate problems that Congress will be dealing with: The first is how to improve food safety on fresh produce — for that we have recommended a certification program to ensure farms operate to a gold standard. The second is how FDA should conduct itself to enhance public health without bankrupting industries so they can’t afford to invest in food safety.

The answer is for Congress to direct FDA to function in an educational fashion on foodborne illness outbreaks unless there is a particular reason to fear high numbers of fatalities or permanent damage.

This preserves the interests public health authorities have in disseminating important information, it helps avoid panic among consumers by putting information in perspective, and it avoids a disastrous impact on food producers by preserving consumer freedom.

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