The hazards of
consuming milk, raw and pasteurized, are real.
We know that a
wide variety of germs that are sometimes found in milk and milk products can
make people sick and sometimes die.
In the United States the CDC’s foodborne disease outbreak
database reports that from 1998 to present there have been 31 outbreaks from
foodborne pathogens in pasteurized milk and solid cheese, representing 2940
total illnesses and 10 deaths.
Similarly, in the same period, there have been 136 outbreaks in raw milk and
raw milk cheeses representing 2464 total illnesses and 2 deaths.1
Two illnesses were reported in Maine attributed to raw milk
in home use but nether of these individuals required hospitalization, and this
milk wasn’t traced to any farm or milk distributor.
Using extrapolated data, another statistical analysis
suggest that annual estimates of foodborne illnesses from dairy may be somewhat
higher, but are recognized in the study as probably overstated because of
methodology.2
By the way, there are other hazards associated with milk
consumption that are often glossed over:
an increased risk of prostate 3-5 and breast cancers,6
insulin-dependent (or type 1) diabetes,7 food allergies, especially
in children,8 and constipation in children.9 Children
suffering from colic has even been linked to breastfeeding mothers’ consumption
of cow’s milk.10 Now none of these hazards will be discussed here,
but we should be aware that there are other health and safety risks to consider
when we talk about food safety in the context of milk.
When we talk about risk,
we’re talking about the chances someone will experience an adverse effect. So let’s put the risk of illness and death
from foodborne pathogens from all milk products, ignoring the other hazards
associated with milk consumption, in context.
We can relatively simply consider the probabilities of death
from consuming these items. Let’s take
the population of the United States over the period 1998 to the present, a
little over 300 million souls.11 Using past data as a guide, the
probability of becoming ill in any one year from a foodborne pathogen
associated with milk, raw or pasteurized, is roughly 1 x 10^-6 which indicates an illness rate of about 1 in 1
million. The probability of dying in any
one year from dairy products is about
2.4 x 10^-8 which indicates a death rate of about 1 in 42 million.
2.4 x 10^-8 which indicates a death rate of about 1 in 42 million.
Reflect on that for a moment. Your odds of dying from consuming milk or
milk products are about 1 in 42 million.
Even given an error of an order of magnitude, we can conclude these
risks are small, given other risks we cheerfully assume.
So let’s compare these risks to risks from other common
activities that we tolerate with little or no discussion. In 2013 alone, there
were 8 deaths and 11,400 hospitalization treatments for non-occupational
fireworks related injuries.12 The odds of becoming injured in such
an accident are about 1 in 36,000 and dying in such an accident are roughly 1
in 37 million.
Annually, 38,000 people require hospitalization from
furniture and television tip overs, and in the 5 years from 2000 through 2014,
there were 430 deaths, 360 of them children under 10 years of age.13
The odds of receiving such an injury are higher than 1 in 8,000, and the odds
of dying from one of these accidents are about 1 in 3.5 million.
An average of 51 people perish from lightening strikes each
year.14 The odds of dying
from a lightening strike are roughly 1 in 5.9 million, and those are an order
of magnitude higher than from consuming dairy products.14 In fact 3 unlucky individuals in Maine died from
lightening strikes in the period 1998 to 2012 while none were lost to the
consumption of dairy or dairy products.15
Consider, for comparison, that an estimate of 440,000 annual deaths from errors in care in
hospitals is roughly one-sixth of all deaths that occur in the United States
each year. Your odds of dying from a
treatment error in hospital are greater than 1 in 700.16
In
this context, please realistically consider the risks associated with the
consumption of raw and pasteurized milk and milk products.
Secondary
to the discussion of statistical risk is the scale of possible adverse
events. If a small milk producer sells
contaminated milk or milk products and his or her clients become ill, the
potential scale of the outbreak, and consequently the number of people
affected, is small. If a large milk distributor sells contaminated milk or
dairy products, since the market and potentially infected population is larger,
the consequences are far greater in terms of public health. Or to use an analogous example by way of
illustration, a farmer selling contaminated beef out of his or her freezer will
affect far fewer people than the population affected by a 1.8 million pound
ground beef recall, as we saw last year17.
So now let’s talk about safety,
that is, the acceptable level of risk. The
riskiest behavior any of us engage in is driving or riding in an automobile
(with odds greater than 1 in 9000 of dying), yet we do it every day.18 We’ve recently legalized non-commercial
fireworks in Maine, knowing the risks and trusting consumers to use them wisely
and safely. Most hotels secure their
television sets to prevent tip overs, yet homeowners typically do not,
assessing the hazard and risk and assuming responsibility for that decision
themselves. We still go to hospital when
needing acute medical treatment, knowing that many preventable errors have high
mortality rates there.
Individuals, knowing the hazards and assessing risks, make
decisions about safety every day. And
they have the capacity to make decisions concerning the purchase of milk and
milk products.
Knowing that we make decisions concerning safety every day,
let’s turn to the inspection process.
There is no recent data that reveal that there have been any illnesses
or deaths from small, uninspected farms in Maine. None.
And do not think that regular purchases of unpasteurized
milk and milk products from uninspected facilities do not occur and are not common. These transactions do occur, and they are
more common than many would like to admit.
In other words, the inspection process by which a patron purchases milk
from an uninspected dairy, as evidenced by the apparent absence of illnesses and
deaths, seems to be effective.
Ponder that for a moment.
Perhaps the relationship and inspection regime that exists between a
farmer and his or her patron may be more effective in making sure the milk and
milk products sold in this type of retail exchange are safe than the
architectural and testing industry requirements that now prevail.
The consumption of milk and milk products does contain hazards.
The epidemiology of illnesses caused by foodborne pathogens is well
known and well documented. The risks associated with the consumption of
these products are less well quantified, but obviously less than some would
have us believe, certainly smaller than the risks many of us willingly assume
every day. It’s important to determine the safety
of these products and the efficacy of a face-to-face inspection model, vis à
vis the architectural and testing model currently in place, with the best
available data.
Let’s recognize patron inspection of dairy facilities as a
legitimate inspection regimen and, given the lack of data to conclude
otherwise, allow the sale of unregulated farm-produced dairy products at the
site of production. I can assure you
that the sky won’t fall, rivers won’t turn to blood, and I don’t foresee dogs
mating with cats any time soon.
2
Painter JA, Hoekstra RM, Ayers T, Tauxe RV, Braden CR, Angulo FJ, et al.
Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities
by using outbreak data, United States, 1998–2008. Emerging Infectious Diseases 2013 Mar http://dx.doi.org/10.3201/eid1903.111866. p. 411.
3Qin L, Xu J, Wang P, Tong J,
Hoshi K. Milk consumption is a risk factor for prostate cancer in Western
countries: evidence from cohort studies. Asia Pac J Clinical Nutrition.
2007;16:467–476.
4Song Y, Chavarro JE, Cao Y, et al. Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians. Journal of Nutrition. 2013;143:189-196.
5Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. American Journal of Clinical Nutrition. 2001;74:549-554.
6 Kroenke CH, Kwan ML, Sweeney
C, Castillo A, Caan Bette J. High-and low-fat dairy intake, recurrence, and
mortality after breast cancer diagnosis. Journal of the National Cancer
Institute. 2013;105:616-623.
7 Saukkonen T, Virtanen SM,
Karppinen M, et al. Significance of cow’s milk protein antibodies as risk
factor for childhood IDDM: interaction with dietary cow’s milk intake and
HLA-DQB1 genotype. Childhood Diabetes in Finland Study Group. Dibetologia.
1998;41:72–78.
8 Sampson HA. Food allergy.
Part 1: immunopathogenesis and clinical disorders. Journal of Allergy and
Clinical Immunology. 2004;113:805–819.
9 Iacono G, Cavataio F,
Montalto G, et al. Intolerance of cow’s milk and chronic constipation in
children. New England Journal of Medicine. 1998;339:1100–1104.
10 Paronen J, Bjorksten B,
Hattevig G, Akerblom HK, Vaarala O. Effect of maternal diet during lactation on
development of bovine insulin-binding antibodies in children at risk for allergy.
Journal of Allergy and Clinical Immunology. 2000;106:302–306.
15
http://www.lightningsafety.noaa.gov/stats/03-12_deaths_by_state.pdf; http://wwwn.cdc.gov/foodborneoutbreaks/Default.aspx.
