A few weeks ago I was giving a talk at the Association of Health Care Journalists conference in Boston. My talk was primarily an overview of where food safety has come since the Jack in the Box E. coli O157:H7 outbreak in 1993. At one point I introduced an article I found in 1993 at the beginning of the Jack in the Box litigation. The article, “Hemorrhagic colitis associated with a rare Escherichia coli serotype.” New England Journal of Medicine, 1983 Mar 24; 308 (12): 681-5., was the report of two outbreaks of an unusual gastrointestinal illness that affected at least 47 people in Oregon and Michigan in the first half of 1982. The illness was characterized by severe, crampy abdominal pain, initially watery diarrhea followed by grossly bloody diarrhea, and little or no fever. It was associated with eating at restaurants belonging to the same fast-food restaurant chain in Oregon and Michigan. This report described a clinically distinctive gastrointestinal illness associated with E. coli O157:H7, apparently transmitted by undercooked meat. I made the point in my talk that I learned that “the same fast-food restaurant chain” was in fact McDonald’s and that I was not aware that the outbreak had been publicized at all at the time. Apparently, making such a statement in a room full of journalists was the right thing to do, as someone promptly “tweeted” me the March 23, 1983 article by the now-retired Daniel Q. Haney of the Associated Press. Haney had written “Fast Food Illness Traced To Rare Bacteria,” in March 1983, and I had missed it in my 1993 research. Apparently, so it appears, did everyone else. Or, worse yet, it was simply ignored. Reading the article 30 years later makes me wonder how often we miss the important things:
A mysterious intestinal ailment that first struck diners at a fast-food chain is a newfound disease caused by rare bacteria, and it has spread across the United States, researchers say. The first major outbreak appeared last year among 47 people who ate at McDonald’s restaurants in Michigan and Oregon. A report on their inquiry into the disease, directed by Dr. Lee W. Riley, was published in Thursday’s New England Journal of Medicine. From the patients’ stool samples, doctors isolated a very rare form of bacteria called E. coli O157:H7. Then they found the same bacteria in a frozen hamburger patty stored at a processing plant. The meat had been kept from a batch that was shipped to the Michigan restaurants. Steve Leroy, a McDonald’s spokesman, declined to comment on the federal report. “It’s hard to predict what’s going to happen,” Riley said. “If it’s like any other food-borne illness, if the original source is not immediately eliminated, then it’s possible that it will stay in the food cycle for a long time to come.”
I decided to reach our to both Dr. Riley and Mr. Haney. I found Dr. Riley at Berkley and Mr. Haney on Facebook, through a reporter I met on Twitter. Both Dr. Riley and Mr. Haney were kind enough to answer a few questions. In 1983 Dr. Riley was a CDC epidemiologist sent to investigate the E. coli outbreak in Oregon. He was the lead author of the NEJM article. At that time, Mr. Haney was a general assignment reporter for AP in Boston with a special interest in science and medicine, so he would cover interesting reports from the NEJM. Dr. Riley recalls that “we at CDC at the time were very ‘excited’ about this E. coli because up to that time, we knew of only three classes of E. coli that caused diarrhea and none of them caused bloody diarrhea or HUS [Hemolytic Uremic Syndrome, a kidney disease brought on by severe E. coli infection].” Dr. Riley also said he believed that “this strain of E. coli had always been around but it was not recognized until the U.S. entered the era of mass production and distribution of hamburger meat to be served at fast-food restaurants — a lot of hamburger patties needed to be consumed to generate a recognizable outbreak.” Mr. Haney recalled that he wrote two versions of the story – one for the morning publication and one for the evening. He recalled thinking at the time that this bug had the potential to create future harm — that the bacteria “could settle in the nation’s food chain if the source of the organism was not found soon.” Ten years later, in Boston, Mr. Haney looked on as the Jack in the Box E. coli outbreak garnered national attention. Dr. Riley recalled thinking that the E. coli problem was not going to disappear anytime soon. He felt that “this E. coli strain had become entrenched in the food animal reservoir and that the increasing animal husbandry practice of producing meat from cattle raised in concentrated animal feeding operations (CAFOs) had only exacerbated the problem.” For me, I still wonder how much more could have been done to prevent the explosion that was the Jack in the Box outbreak. Had Dr. Riley’s NEJM article been publicized more widely would more have been done in the intervening decade? What if other reporters had covered E. coli more in depth in the 1980s? Clearly, at least as it relates to ground beef, the beef industry, restaurants and government have made great strides in preventing E. coli illnesses and outbreaks. As I have said before, in the decade after Jack in the Box, 90 percent of my law firm’s revenue came from E. coli cases linked to hamburger. That percentage in now near zero. Interventions at slaughter and increased cook temperatures and times, along with E. coli O157:H7 being considered an adulterant by the USDA/FSIS, have all helped. But, E. coli has now found its way into foods as varied as spinach, lettuce, cookie dough, apple juice and cheese, and it has become an ever-increasing problem at water parks and petting zoos. And, unfortunately, those cases have become a bigger and bigger part of what I do each day.