Health And Fitness Article

Current research, published in the journal Molecular Nutrition and Food Research, suggests that an increase in our daily dose of vitamin D could prevent premature death; specifically the death rate in Canada could be reduced by about 16%, implying that up to 37,000 premature deaths could be prevented each year.

In addition, an increase in our vitamin D levels could save as much as $14.4 billion in Canadian health care costs. “Personal and economic burden of disease in Canada could be significantly reduced if optimal vitamin D levels are increased," says primary author William Grant, of the Sunlight, Nutrition and Health Research Center in San Francisco.

Increased vitamin D intake could considerably diminish the incidence of various conditions such as cardiovascular disease, multiple sclerosis, pneumonia and cancer. The study estimates that the benefits of increased vitamin D levels would include: 

• decreased cancer rates of 25 per cent by increasing national vitamin D levels from 75 to 105 nmol/L 
• lowered risk of cardiovascular disease by 25 per cent if levels are increased from 62.5 to 105 nmol/L 
• a 60 per cent improvement in insulin sensitivity if vitamin D levels were increased from 25 to 75 nmol/L 
• reduced risk of developing multiple sclerosis and reduced symptoms in those already diagnosed 
• reduced risk of pneumonia by 30 per cent, by reducing the "cytokine storm" response following respiratory infections 
• reduced risk of Cesarean section by about 50 per cent, by strengthening the uterine muscles 
• improved fetal development

Vitamin D is a group of fat-soluble prohormones, the two major forms of which are vitamin D2 (or ergocalciferol) and vitamin D3 (or cholecalciferol). Vitamin D obtained from sun exposure, food, and supplements are biologically inert and must undergo two hydroxylation reactions to be activated in the body.

Vitamin D is naturally produced by the human body when exposed to direct sunlight. In many countries, such foods as milk, yogurt, margarine, oil spreads, breakfast cereal, pastries, and bread are fortified with vitamin D2 and/or vitamin D3.

The study declares that the average Canadian has about 67 nanomoles per litre of vitamin D in their bloodstream, while levels must be about 105 nmols per litre to produce any real benefits for reducing disease. Many experts believe that 75 nmols per litre is required to maintain good health. According to this study, most Canadians are not getting the recommended daily dose of vitamin D to maintain good health, let alone enough to prevent disease and premature death. The National Institutes of Health suggests that the minimum amount of international units of vitamin D required for maintaining good health is:


Most often, vitamin D must be ingested either through whole foods or supplements since sun exposure and skin cancer risk is a concern on its own. The table below outlines the international units of vitamin D found in various natural foods:


“The U.S. Institute of Medicine is currently working on setting new dietary reference intakes for vitamin D, and Canadian officials are involved in the process. A report is expected to be published in late summer or the fall.”

According to several news sources, Amanda Flowers, of Manchester, England, has recently been diagnosed with persistent genital arousal disorder as a result of falling off her Wii Fit board and damaging a nerve. She admits to having sexual urges up to 10 times a day since the incident.

"It began as a twinge down below, before surging through my body," Flowers told a U.K. newspaper. "Sometimes it built up into a trembling orgasm."

Dr. Sandra Leiblum, of the Center for Sexual and Relationship Health at the Robert Wood Johnson Medical School in New Jersey, coined the term in 2001 as Persistent Sexual Arousal Syndrome (PSAS).

It has also been referred to as Restless Genital Syndrome or Mempin Syndrome. It is now known as Persistent Genital Arousal Disorder (PGAD) and symptoms include spontaneous and persistent genital arousal, with or without orgasm or genital engorgement that are unrelated to any feelings of sexual desire.

The disorder is not related to hypersexuality, nymphomania or satyriasis. The condition is very rare and frequently unreported because of its accompanying feelings of shame and embarrassment.

Arousal can be very intense and persist for extended periods, even days or weeks at a time. “Orgasm can provide temporary relief, but within hours the symptoms return. The symptoms can be debilitating, preventing concentration on mundane tasks”. Simple things such as riding in a car, vibrations from a cell phone or urination can exacerbate the condition.

Unfortunately, the exact cause is unknown due to a lack of knowledge of the particularities of the disorder. Some medical professionals believe that it is caused by an irregularity in sensory nerves. The disorder is more common in post-menopausal women in their 40s and 50s, or those who have undergone hormonal treatment, but it can occur at any age.

Occasionally, the disorder may be a side effect of certain medications, such as trazodone, or as a result of discontinuing selective serotonin reuptake inhibitors (SSRIs). “In some recorded cases, the syndrome was caused by a pelvic arterial-venous malformation with arterial branches to the penis or clitoris; surgical treatment was effective in this case.”

Treatment is not typically straightforward nor is it always 100% accurate. Antidepressants, antiandrogenic agents and anaesthetizing gels can help to reduce the intensity of the symptoms. In addition, psychotherapy along with cognitive reframing can be used for treating the disorder.

“More recently, the symptoms of the condition have also been linked with pudendal nerve entrapment. Regional nerve blocks and less common surgical intervention have demonstrated varying degrees of success in most cases.”

With any luck, the popularity of the Nintendo Wii will ensure widespread media coverage of this accident that will hopefully lead to more research on Persistent Genital Arousal Disorder and help those that may be suffering from this condition.

SATURDAY, JUNE 5, 2010

Medication Could Prevent Diabetes
New research published in The Lancet suggests that taking low doses of the popular diabetes drugs Avandia and metformin reduce the risk of type-2 diabetes in patients with pre-diabetes.

Side effects of Avandia include fluid retention, heart failure and, possibly, heart attacks, while side effects of Metformin only include upset stomach. Therefore, researchers chose to use a combination of the two drugs to lessen the risk of side effects.

The study included 207 patients with pre-diabetes. They were given two pills a day, both Avandia and Metformin or 2 placebos. In the 4 year study it was found that 14% of patients treated with these medications developed diabetes as opposed to 39% of those treated with a placebo.

Supposedly, the typical side effects of Avandia were not present; however 4 years is insufficient time to verify incidents of heart failure or heart attacks.

“The effect would likely be the same with Avandia's rival drug in the same class, Takeda's Actos, said Dr. Bernard Zinman of Mount Sinai Hospital at the University of Toronto, who led the study.”

Other generic brands include, pioglitazone, rosiglitazone, which belong to a class of drugs called thiazolidinediones help the body better use insulin.

“Type-2 diabetes is caused as the body gradually loses its ability to respond to insulin, a condition called insulin resistance. Overeating, a lack of exercise, genes and other factors all play a role.”

Gradually, beta cells in the pancreas begin to lose their ability to make insulin, which raises levels of glucose in the blood. In turn, these high levels of glucose begin to damage blood vessels and eventually organs.

GlaxoSmithKline admits to settling more lawsuits recently that allege Avandia caused heart attacks. In addition, sales of Avandia topped $3 billion in 2006, but fell to $1.2 billion in 2009.

Dr. Bernard Zinman of Mount Sinai Hospital at the University of Toronto and leader of the study affirms that it won’t be long until generic forms of Avandia and Actos are available, which suggests a less expensive treatment for diabetes prevention.

"The concept of combining submaximum doses of effective drugs to maintain efficacy and reduce side-effects is an attractive one," Dr. Thomas Buchanan of the University of Southern California wrote in a commentary.

Are we really in such a slothful society that medication as a method of prevention has overruled healthy lifestyles? Diabetes is a serious and debilitating disease so it may be necessary for those who are very at risk that could benefit from this type of treatment, but it is by no means the ultimate solution as even with medication the disease may still progress.

“The International Diabetes Federation estimates that 300 million people worldwide have pre-diabetes and 230 million have diabetes.”

Half doses of diabetes drugs can prevent disease

© www.thehealthnewsblog.com

POSTED BY MEG AT 9:11 AM 0 COMMENTS
LABELS: AVANDIA, BETA CELLS, DIABETES, GLAXOSMITHKLINE, GLUCOSE, HEART ATTACK, HEART FAILURE, INSULIN, METFORMIN, PANCREAS, PIOGLITAZONE, PRE-DIABETES, RESEARCH, ROSIGLITAZONE, THIAZOLIDINEDIONES


SUNDAY, APRIL 25, 2010

Salmonella Vaccine Could Benefit HIV-Infected Adults
It is well known that HIV-infected adults are more vulnerable to fatal strains of salmonella, however new research sheds light on this link. The crisis is more substantial in Africa, where salmonella is relatively common. In addition, the problem is amplified by the fact that no vaccine exists to fight this bacterium and people are becoming increasingly resistant to antibiotics currently being used to treat the disease.

“Nontyphoidal strains of Salmonella (NTS) usually cause vomiting and diarrhoea in high-income countries and are mainly contracted by consuming infected foods, such as uncooked meat and eggs. NTS can also cause fatal bloodstream infections in people with compromised immunity, such as HIV-infected individuals, and children under two years of age or with malaria, anaemia or malnutrition.”
New research tested the blood’s ability to kill salmonella in both uninfected adults and infected African adults. Results showed that antibodies in the blood samples of the uninfected adults were able to kill the salmonella with ease; however the blood of the infected could not. Despite the deficiencies in the compromised immune systems of those infected with the disease, high levels of salmonella-fighting antibodies were found in their blood samples. However, these antibodies were not able to fight the salmonella. Furthermore, the antibodies in the blood of HIV-infected adults actually prevented the antibodies in uninfected adults from eliminating the bacteria.

In a normal functioning immune system, antibodies bind to the outer membrane proteins on the surface of the salmonella bacteria in order to eliminate it, while antibodies in HIV-infected Africans prevent the elimination of the bacteria by blocking them from binding to the surface of the salmonella, rather they bind to the lipopolysaccharide (LPS) instead.

“When the researchers specifically removed the blocking antibodies from HIV-infected blood samples, they found killing antibodies present in the blood that could once again kill the bacteria. This shows that people infected with HIV still have the protective killing antibodies generated in the first two years of life that can control Salmonella infection, but the excess of blocking antibodies stops the killing antibodies from working.”
The study suggests that it is not a lack of antibodies, but an excess of antibodies that prevents the compromised immune system in HIV-infected adults from successfully fighting bacterial infections.

"The findings are important because LPS is currently being investigated as a potential target for a vaccine. Our observations that antibodies targeting LPS can actually impede the protective immune response to Salmonella would caution against this, suggesting that such a vaccine could do more harm than good." Alternatively, the outer membrane proteins of salmonella may be a more appropriate target for a new vaccine.

HIV Patients Hold Clues to Salmonella Vaccine Development

© www.thehealthnewsblog.com

POSTED BY MEG AT 10:42 AM 1 COMMENTS
LABELS: ANAEMIA, ANTIBIOTICS, ANTIBODIES, BACTERIA, HIV-AIDS, IMMUNE SYSTEM, LIPOPOLYSACCHARIDE, MALARIA, MALNUTRITION, SALMONELLA, VACCINE
FRIDAY, APRIL 16, 2010

Increasing Health Concern For Brain Tapeworm
Loyola researchers wrote in the journal Neurological Research that a serious and increasing health concern exists in Mexico and bordering southwestern states. In Mexico, up to 10% of the population may be infected by neurocysticercosis, a tapeworm in the brain.

“Neurocysticercosis, is the most common parasitic infestation of the central nervous system worldwide. Humans develop cysticercosis when they ingest eggs of the tapeworm Taenia solium.”

One becomes infected with this parasite by ingesting eggs or larvae from undercooked pork or through contaminated food, water or surfaces.

“Once inside the stomach, the tapeworm egg hatches, travels through the bloodstream and ends up in the muscles, brain or eyes. The worm, which can grow to more than one-half inch long, becomes enveloped in a fluid-filled cyst.”

Cysts found in muscles generally don't cause any symptoms, while those found in the eyes can cause blurred vision. The most damage is found in cysts in the brain. They can cause headaches, encephalitis and even seizures. At times, they may cause confusion and balance problems.

This type of infection is more common in poor rural communities in developing countries, especially where there is poor sanitation and hygiene.

Stage 1: Cysts begin to develop and appear within 1–4 weeks in the brain. People are typically asymptomatic during this phase, although rare, flu-like symptoms, seizures and increased intracranial pressure from massive infestation have been recorded.

Stage 2: Cysts mature by about 2 months after initially ingestion. Stage 2 cysts are also asymptomatic, and can persist for more than 10 years.

Stage 3: Cysts contain thick cystic fluid, thickened capsule, and appear two to 10 or more years after the cyst has matured. Most patients in this stage develop symptoms such as seizures, occasional focal neurological signs, headaches, nausea, vomiting, lethargy from increased intracranial pressure and altered mental status.

Stage 4: Cysts are calcified. Symptoms include persistent non-provoked seizures although most patients are asymptomatic.

Treatment may include medication or corticosteroids or surgery. Improving sanitation and increasing awareness may help to reduce the spread of the infection.

It is well known that HIV-infected adults are more vulnerable to fatal strains of salmonella, however new research sheds light on this link. The crisis is more substantial in Africa, where salmonella is relatively common. In addition, the problem is amplified by the fact that no vaccine exists to fight this bacterium and people are becoming increasingly resistant to antibiotics currently being used to treat the disease.

“Nontyphoidal strains of Salmonella (NTS) usually cause vomiting and diarrhoea in high-income countries and are mainly contracted by consuming infected foods, such as uncooked meat and eggs. NTS can also cause fatal bloodstream infections in people with compromised immunity, such as HIV-infected individuals, and children under two years of age or with malaria, anaemia or malnutrition.”
New research tested the blood’s ability to kill salmonella in both uninfected adults and infected African adults. Results showed that antibodies in the blood samples of the uninfected adults were able to kill the salmonella with ease; however the blood of the infected could not. Despite the deficiencies in the compromised immune systems of those infected with the disease, high levels of salmonella-fighting antibodies were found in their blood samples. However, these antibodies were not able to fight the salmonella. Furthermore, the antibodies in the blood of HIV-infected adults actually prevented the antibodies in uninfected adults from eliminating the bacteria.

In a normal functioning immune system, antibodies bind to the outer membrane proteins on the surface of the salmonella bacteria in order to eliminate it, while antibodies in HIV-infected Africans prevent the elimination of the bacteria by blocking them from binding to the surface of the salmonella, rather they bind to the lipopolysaccharide (LPS) instead.

“When the researchers specifically removed the blocking antibodies from HIV-infected blood samples, they found killing antibodies present in the blood that could once again kill the bacteria. This shows that people infected with HIV still have the protective killing antibodies generated in the first two years of life that can control Salmonella infection, but the excess of blocking antibodies stops the killing antibodies from working.”
The study suggests that it is not a lack of antibodies, but an excess of antibodies that prevents the compromised immune system in HIV-infected adults from successfully fighting bacterial infections.

"The findings are important because LPS is currently being investigated as a potential target for a vaccine. Our observations that antibodies targeting LPS can actually impede the protective immune response to Salmonella would caution against this, suggesting that such a vaccine could do more harm than good." Alternatively, the outer membrane proteins of salmonella may be a more appropriate target for a new vaccine.

New research published in The Lancet suggests that taking low doses of the popular diabetes drugs Avandia and metformin reduce the risk of type-2 diabetes in patients with pre-diabetes.

Side effects of Avandia include fluid retention, heart failure and, possibly, heart attacks, while side effects of Metformin only include upset stomach. Therefore, researchers chose to use a combination of the two drugs to lessen the risk of side effects.

The study included 207 patients with pre-diabetes. They were given two pills a day, both Avandia and Metformin or 2 placebos. In the 4 year study it was found that 14% of patients treated with these medications developed diabetes as opposed to 39% of those treated with a placebo.

Supposedly, the typical side effects of Avandia were not present; however 4 years is insufficient time to verify incidents of heart failure or heart attacks.

“The effect would likely be the same with Avandia's rival drug in the same class, Takeda's Actos, said Dr. Bernard Zinman of Mount Sinai Hospital at the University of Toronto, who led the study.”

Other generic brands include, pioglitazone, rosiglitazone, which belong to a class of drugs called thiazolidinediones help the body better use insulin.

“Type-2 diabetes is caused as the body gradually loses its ability to respond to insulin, a condition called insulin resistance. Overeating, a lack of exercise, genes and other factors all play a role.”

Gradually, beta cells in the pancreas begin to lose their ability to make insulin, which raises levels of glucose in the blood. In turn, these high levels of glucose begin to damage blood vessels and eventually organs.

GlaxoSmithKline admits to settling more lawsuits recently that allege Avandia caused heart attacks. In addition, sales of Avandia topped $3 billion in 2006, but fell to $1.2 billion in 2009.

Dr. Bernard Zinman of Mount Sinai Hospital at the University of Toronto and leader of the study affirms that it won’t be long until generic forms of Avandia and Actos are available, which suggests a less expensive treatment for diabetes prevention.

"The concept of combining submaximum doses of effective drugs to maintain efficacy and reduce side-effects is an attractive one," Dr. Thomas Buchanan of the University of Southern California wrote in a commentary.

Are we really in such a slothful society that medication as a method of prevention has overruled healthy lifestyles? Diabetes is a serious and debilitating disease so it may be necessary for those who are very at risk that could benefit from this type of treatment, but it is by no means the ultimate solution as even with medication the disease may still progress.

“The International Diabetes Federation estimates that 300 million people worldwide have pre-diabetes and 230 million have diabetes.”

Past studies have shown that men with younger wives live longer. But what about women with younger husbands? The theory was that an effect called “health selection” would apply to them, too: that those of us able to attract younger spouses are healthier and therefore already have a higher life expectancy. And younger spouses can better care for us in our old age, extending our life span.
Except according to new research by Sven Drefahl of the Max Planck Institute for Demographic Research, who studied 2 million Danish couples, the larger the age gap between a wife and her husband, the lower her life expectancy—especially if her husband is younger. While men who marry women seven to nine years younger rather than someone their own age lower their risk of dying by 11 percent, a woman who marries a man seven to nine years younger increases her mortality risk by 20 percent.
Why would younger spouses extend the lives of men but not women? Researchers aren’t sure, but it’s likely that women don’t benefit psychologically and socially from a younger partner the way men do because they spend more time with their friends than do their husbands. And, adds Drefahl, women who marry someone younger might suffer more stress and receive less social support than women who, more traditionally, marry older men:

One of the few possible explanations is that couples with younger husbands violate social norms and thus suffer from social sanctions.

A woman’s best bet, he found, is to marry someone exactly the same age.

Validation is a key part of the verification process. Verification in HACCP requires that we first determine if the process has effective controls and secondly that the controls are operating as required. Basically, what every HACCP Plan has required since the inception of HACCP is valid documentation. The concept of validity means much more however, and the world body known as the International Standards Organization in Geneva Switzerland has developed an ISO standard for managing HACCP that requires that the operator not only monitor the system and keep valid records, but that the systems for control have been validated. This means controls must meet a standard that provides assurance that when they are met, hazards are under control. Without such standards there can be no validity to measurements.

Validity means the degree to which an instrument, selection process, statistical technique, or test measures what it is supposed to measure. Without standards it is impossible to measure as there is nothing to compare the measurements to. ISO approaches these issues by providing the definitions below.

Notice the term evidence is used in the definition of validation. Without microbiological, chemical, physical and radiological tests results (evidence), hazards will go unrecognized. Without criteria for the tests they will not provide the evidence required by ISO to ensure safety. Notice also that end products can not be assumed safe simply by monitoring a critical limit like chlorine residual in a water system, verification of the process, validation of the critical limits, and documentation are also necessary.

Notice in verification that specified requirements must be provided.

An example of a problem when validation and verification is ignored might be a situation where a water quality management system has identified that a significant contamination problem exists and assumes that by chlorination the system will be capable of effective control of hazards, but does not validate that the controls are effective. The problem with this is that EPA for example requires not only that the system maintain an FAC between 0.2 ppm and 4.0 ppm but that the water is free (<10) of Legionella species as well as total coliform, and HPC ( below 500 ppm) . Verification of such a system is impossible without testing against these standards (criteria) and the hazards may be there in spite of a predefined upon critical limits, depending on a number of factors, most importantly, dead end loops, chlorine demand and monitoring methods.

Verification and validation are therefore both essential to water quality management systems and all HACCP systems. ISO provides in-depth and clear definitions for these terms below: ISO 22000:2005.

Public health policy and food protection are issues that we expect the new Obama administration to address eagerly. Financial problems, wars in Afghanistan and Iraq, and Home Land Security have shifted focus away from our core public health agenda, and now is the time to return our focus. Everyone agrees that public health programs have suffered in the last eight years. Keep in mind, however, that public health protection is possible in the US more so than in many places around the world. We have public health infrastructure, a little decrepit, but still there.
The new administration should take an accounting of what is on the ground now, what is working and what is not, and develop a comprehensive plan of action similar to the "President's Food Safety Initiative" of 1998.. Safety-net type programs that were instituted like PulseNet www.cdc.gov/pulsenet/ and FoodNet www.cdc.gov/FoodNet/ are now very valuable. If the new administration is wise, it will invest in these and other types of surveillance programs and set meaningful public health goals. Most importantly, the new administration must implement strategies to achieve its goals based on science and a risk assessment.
The Obama team should develop true partnerships where government and industry equally share the burdens of food protection. One possible way to do this is to strengthen the existing industry-driven, self-regulation model. The Obama administration can accomplish this through better federal agency oversight and verification of the entire food supply chain. Presently, there are major gaps in federal regulation of the US food supply that weaken industry efforts.
Applying technology is a quick way to move forward rapidly. For example, the food industry is applying sophisticated food safety data capture devices in their food safety management systems. Programs are built into common platforms that run on the I Phone and PDA of a wide assortment. Data is also transmitted through the Internet to database management systems that track and analyze data-see http://www.scbs.net.au/index.htm. Tapping into the resources of industry food-safety professionals and the available technology can definitely strengthen public health protection.
“One big agency” to bring all regulation for the food supply under one umbrella is a compelling thought that the Obama team must evaluate. The new administration should consider first, however, how to enhance what is already functioning. There may be some advantages in combining some functions of the USDA Food Safety and Inspection Service-see www.fsis.usda.gov/and the FDA Center for Food Safety and Applied Nutrition-see www.foodsafety.gov/list.html.
Without question, the new administration should call for more coordination and better allocation of resources in both USDA and FDA, and then properly fund these agencies to meet the administration’s public health goals. The last administration failed to recognize that our agencies have been less than capable in managing the risks in the US food supply. This administration should first honestly evaluate the successes and failures of current public health policies as regards food safety and other pressing matters and then lead us forward.
We recommend that the administration seriously look at the Office of the Surgeon General- see www.surgeongeneral.gov and strengthen the role of the nation’s "Chief Health Officer". The Surgeon General has not voiced any support for food safety efforts since he last spoke out publically on the issue, back in 1999. This vastly underutilized post should come to the fore under President Obama. We should expect the Surgeon General's Office to take initiatives in the interest of public health to elicit more support and involvement in food safety from the medical and public health communities, and to speak to the American people about food protection.

In years past the practice in the US was to require a health certificate to work in the food industry. While on the surface this sounds like something to consider, the use of medical evaluation of food workers was often done without specific tests, medical personnel relying on medical history and a physical exam. Without specific tests carriers of infection are difficult to detect, and such exams alone cannot predict future health status. In many parts of the world, this practice is still evoked while it is no longer considered to be necessary in the US.
Since a medical screen is relied upon by some as a preventive measure, our scientific methods of developing food safety systems makes us have to evaluate the validity of this process. We must determine the reliability of results for preventing foodborne illness alone. In a food safety system, other communicable disease such as sexually transmitted disease, or strictly respiratory diseases like TB or influenza do not enter into the hazard analysis..
A medical screening process proven effective through a validated method would be in conformance with ISO22000:2005 or HACCP methods; requirements based on them would then be food safety preventive measures.
To be in conformance, tests must be specific for etiological agents of disease, be predictive of communicable disease status at time of employment and be relative to future health status. Reliable tests provide the validity for a medical exam at time of employment. Tests for Salmonella typhi, Giardia, other protozoan and higher parasites, skin and upper respiratory infections (staph and strep) and other chronic or semi chronic disease (hepatitis A-D, mononucleosis) transmissible through food might be considered. In addition, triage of employees might be beneficial in a “hazard analysis” context as one might try to discriminate and sort between:
1) Those who are not infected and not likely to be infected in the future
2) Those who are likely to be infected in the future
3) Those who are likely to be infectious now
4) Those for whom immediate care might make a positive difference in outcome
The food safety and public health benefits of any medical-screening model needs to be tested before including it in a food safety management system.
In the past, the medical screening of food workers has proven not to be predictive of future infectious status and both the public health and medical communities question its value in public health protection.
While each country and region has its own relatively unique disease transmission issues, prevention of disease in the first place is always better than testing for it afterwards.

No one disputes the fact that our food safety net has several gaping holes. Like clockwork, one can seemingly depend on a major foodborne illness outbreak to occur every few weeks. This month it is peanut butter, again, a few months back it was peppers and tomatoes, before that potpies, veggie snacks, canned chili, etc, etc.
Proponents for a massive reorganization of our regulatory agencies continue to make their voices heard. However, few if any of these proponents really appreciate what has caused the dysfunction in our food safety systems. A reorganization of our federal agencies is a dangerous idea that simply will not work and political motives are behind much of the "One Big Food Safety Agency" movement.
While our agencies do seem overwhelmed, actually the solutions are relatively simple; more industry self-control and more oversight by a properly funded and managed government would make a world of difference.
First, industry self-controls should be mandatory, not voluntary! Regardless of the industry, process or commodity, it is the producer that holds the key to food safety. Yet, except for red meat, juice, poultry, seafood and the dairy industry, most of the food industry, including the entire food service industry operates with no formal requirements for a food safety system. Industry self-control does not necessarily mean government should back away from its authority. In fact, mandatory self-regulation would bolster governmental efforts if government were in true partnership with industry and not simply shifting the cost and burdens of public health protection, as seems to be the case.
When operators properly develop and implement food safety systems, they work. Health authorities are no longer reporting juice outbreaks. Statistics show some progress in reducing outbreaks of E. coli O157:H7 in red meat, especially at the retail level and there are very few reports of large-scale outbreaks of salmonella from poultry. This is probably the result of government-mandated self-regulation, although it is somewhat uncertain why we see declines in outbreaks in some pathogens.
The record of the highly regulated seafood industry is remarkably good. We do not have nationwide outbreaks associated with seafood. While groups such as the Centers for Science in the Public interest have misunderstood the statistics related to seafood outbreaks, the seafood industry is undoubtedly one of the safest in spite of the fragility and propensity for bacterial growth of its products.
Government, especially the FDA, is terribly underfinanced, poorly managed and lacks political support. Its counterpart, USDA, seems to fare a little better in its budget, but politics at the highest levels in USDA ensures less effectiveness as a public health agency. These two facts are the major reasons we have a weakened food safety system. Opponents of self-regulation should consider that a mandatory self-imposed food safety system with a strong government oversight is a very different model from voluntary self-regulation where government has no jurisdiction, or abdicates its authority.
An example for how things are improving exists today in the produce industry, probably the most hazardous of all food industries. The California leafy greens industry and the Florida tomato industry have adopted self-regulation, and in the absence of federal oversight, state government has stepped in to provide the needed regulatory oversight. We have an excellent developing model where strict governmental regulations of producers are coupled with demands from buyers for validated self-control systems. We need across the board what is happening in Florida and California, and not just in the produce industry. If we had mandatory industry self-control, coupled with strict government oversight, large-scale foodborne illness outbreaks would stop, and sporadic incidence would dramatically drop.
The panacea of creating One Big Food Safety Agency will not solve our food safety problems. It will however make it much worse. As a government manager who has been through government reorganization, I will tell you it takes years for the agency to recover. Generally, the politics that occur are so damaging to morale and the mission of the agency that any meaningful efforts come to a standstill. It is incredibly naive to think that two massive agencies with 100 years of protocols and independence can be merged into a single agency successfully just by an edict in Washington. While the problem of “who inspects what pizza” makes good fodder for those with an anti-regulatory agenda, this archaic problem can be easily solved by an interagency agreement, or memo of understanding between the two agencies.
If Mr. Obama is smart, he will look to make USDA and FDA efficient and accountable and give them the support they need. These agencies have served us very well up until recently when politics and politicians gutted FDA. USDA is a separate problem. USDA has suffered by being an advocate for industry while simultaneously shouldering a serious public healthy responsibility.
Food safety is a critical public health issue, so what are the leaders in public health concentrating on? Take a look at the American Public Health Association, or the Association of Colleges of Public Health. They are bellwethers for what is on the mind of the public health scientists in this country. Few in these groups are seriously interested in food safety. Colleges of public health do not teach food safety as a public health specialty although there may be a lecture or two in the environmental health track. A long-term solution to strengthening the food safety system is for the public health academic community to attract and train more qualified food safety experts and deploy them into both regulatory and industry food safety positions. It is time for the public health scientists to get out their ivory academic towers and embrace contamination of the food supply as a major public health concern.
We should not waste precious resources in a useless and dangerous reorganization of the federal bureaucracy. It is time for public health scientists, industry leaders and government officials to develop an initiative similar to the “President’s Food Safety Initiative” of 1998. The result of the 1998 effort yielded tremendous progress on many fronts, very cost-effectively.
Providing leadership in Washington, sensible tweaking and funding of our existing regulatory systems, and requiring industry to shoulder more weight to protect the public are what we need. Advocating for “One Big Food Safety Agency” is a colossal mistake in thinking and such an effort will guarantee that we fall further behind the microbes in their incessant attack on people through food. Thankfully, President Obama is probably going to be too busy to make this happen anytime soon.

The food safety net just showed us another huge tear as the result of contaminated peanut butter products. The problem will be felt for years in the peanut industry and will likely change the food safety landscape in many ways.

The government reaction has been harsh and focused in this latest deadly outbreak. More government action means more regulation, and as yet, we have not seen any sweeping changes, but they are likely to come. For the first time we have the highest level of government showing concern, namely the White House. The One Big Agency concept keeps emerging and it is good to examine why proponents believe it is necessary, namely reducing duplication and closing gaps. There is also the idea that policy on food safety could come from one office. We now also have possible criminal behavior on the part of one of the food industry, and the legal consequences of causing an outbreak are becoming clearer and deeper. On the positive side, in this latest crisis there is a real sense of openness for change.

The foodborne outbreaks caused by once thought harmless items such as peanut butter has been the icing on the cake for a very mean period in the history of food safety. It is ironic that at the time the food safety concept is rapidly growing, the hazards keep building against controls.

The question is what we are going to do about it; what do we do before something like this happens again? We have had in the past a vacuum as far as any true leadership to get us out of the problem. Its been a long time since there were any definitive changes in the way we do food safety and there is real room for improvement. So what are we going to do prevent the next outbreak? Do we call for more reforms? Is this the same pattern of business as usual or do we expect something a little bit more decisive from government after peanuts?

Obama joins calls for improving US food safety regime:
http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/feb0209fda.html

Peanut butter may get 'high risk' designation as government tightens oversight of food makers
http://www.startribune.com/politics/national/congress/39465507.html?elr=KArks8c7PaP3E77K_3c::D3aDhU6:_0c:QyDiiUiacyKUnciaec8O7EyUr

With both the New York Times and the Atlanta Journal Constitution reporting on inspections and audits, audit company auditors and the third party food safety scheme are coming under fire. There is ample evidence that both the third party audit model and regulatory inspection model have deficiencies, as brought out by the most recent PCA incident and other food safety crises. There appears to be some confusion however about the root causes of these deficiencies, and we should differentiate third party audits from regulatory inspection. The scopes and purposes of these audits are different in important ways while sharing many similarities.
Third party audits seek to evaluate and examine conformance with a private food safety standard, while of course regulatory audits seek compliance with public health rules and laws. Private companies own and develop the third party audit standards, and although FDA has begun looking at a certification process for such firms, they act independently from regulatory agencies and are not bound to evaluate all laws and rules relative to a firm.
The scope of the audit limits the third party auditor in determining conformance while the government inspector is bound to determine compliance with the code and seek enforcement. An auditor may find himself narrowly looking at criteria as specified by the standard, and the policies of the auditing company. For example, in a manufacturing environment, the auditor may be interested in one or two lines or one or two processes for a particular labeled good, and find that the scope of the audit does not cover some otherwise important areas of the whole operation and its products.
The strength of the audit from a public health perspective is basically that the audit goes deeper into management systems that support the compliance with laws than most regulatory inspections. The strengthens of the regulatory inspection is that violations of a food safety nature trigger enforcement at some level, re inspection, condemnation and embargo of product and other interventions not available to the third party auditor. Regulatory agencies also have (or should have) the power to compel compliance and the release of vital food safety information such as microbiological tests data, and demand a recall.
The two systems are therefore complimentary and both together have the capacity to bring about public health protection. We can improve the two systems and bring them closer together in a number of ways. The third party auditing company should have the ability to withhold certification based on its own criteria. This means that even a firm who might achieve a Superior Rating could have their certifications withdrawn if they fail to stay in substantial compliance with laws and rules, withhold information about the safety of the product or process, or engage in fraudulent activities. This is currently not the case in many audit schemes, the decision to do business with a supplier is left totally to the buyer who can opt to make a buying decision, based solely on the audit criteria.
We can strengthen the regulatory model in a number of ways. Currently, many food safety agencies are under staffed, poorly funded, and ineffective at regulation. The fragmentation of public health is something the food industry has brought upon itself. Industry must seek to obtain proper funding for food safety agencies or must agree to fee increases to keep these very necessary functions going . Industry must support agencies to expand their jurisdiction.
Third party audits alone will not protect public health, and public health is greatly improved by the independent review of food safety management systems by an outside expert. However, the owners of private standards do not intended to be public health protection agencies and their standards should not take the place of a farm to fork regulatory framework for food safety. The shakiness in this framework is the underlying cause of our food safety dilemma and industry is finding that its third party, buyer driven standards alone will not properly protect their own interests or public health.

In the absence of food safety regulations in many commodities or the lack of oversight in general, companies have turned to the private regulation of the food supply. On an individual and voluntary basis, dozens of auditing firms and hundreds of private parties are looking closely at the safety of thousands of suppliers. The supplier-food safety scheme is pushing all the way back from the retailer to the primary producer or farmer. As each link in the supply chain tightens standards, there will be a corresponding improvement in the safety of final products.
The third party food safety business model is that buyers ”accredit” or approve the third party food-safety firms they will accept audits from, and suppliers are free to hire whatever firm they wish to satisfy the buyer. The supplier pays the auditing firm directly and the auditing firm sends the audit findings to the buyer. The buyer does not pay for the audit and the findings do not bind his purchasing decision.
Third party audits have the capacity to improve food safety and provide another means of protection in the wake of government inaction or even failure. Third parties use private food safety standards developed either in partnership with prospective buyers or in formal expert groups at the national and international levels. They provide the basis for determining “conformance” whereas regulations provide the basis or scope of the regulatory inspection, which is “compliance”. Third party audits cannot take the place of regulatory inspection in protecting the consumer for the simple fact that only government has the legal power to enforce compliance. Third party audits since they are voluntary often take on a collaborative air. A buyer maintaining good working relationships with his auditing companies makes good business sense and adversarial relationships are not productive. Bias can easily slip in when the audit customer and the auditing firm grow too close. Bias can enter from the supplier side as well. When choosing an auditing firm a supplier may decide to select a firm based on price, personal knowledge of the company and its personnel, as well as the strength of the auditing system and its recognition.
The premise for any company to hire an auditing firm is the needs of the buyer who is more than likely requesting the audit. The consumer benefits from the third party scheme in more consistently safe products but protection is weak when the most hazardous facilities continue to operate. Disqualification of a supplier is the responsibility of the buyer, but the audit findings in no way bind the buyer. Third parties can rate a firm but they cannot dictate to the buyer who to use. In such an unregulated system, unsafe operations continue to operate and distribute unsafe food to consumers who continue to become ill and die. Unsafe operations continue even when audits reveal clear significant problems and more troubling, sometimes auditors do not clearly report unsafe conditions.
Bias can work in another way. Since the auditing firm really wants the suppliers business, relationships between suppliers, auditors and firms may develop. If those personal relationships cloud the findings and discretion of the auditor, the system becomes very weak.
Shifting the weight for protecting the consumer to third parties alone is not a good system and is simply “passing the buck”. There must be at the basis for the model, a comprehensive and competent authority with enforcement powers and consistent presence. We cannot rely upon independent third parties for this. Government authority backing up the system greatly improves the third party model and gives it credibility especially when efforts are coordinated with industry. Government acting in tandem with industry third parties and thus the industry itself brings us full circle in the evolution of food protection efforts. Such an effort would pave the way for a significant improvement in the safety of foods and the protection of consumers.

Inspections during Foodborne Illness Outbreaks
When a public health agency becomes aware of an outbreak of foodborne illness, they put into place interventions to stop the transmission. Central to that effort is an environmental assessment referred to as an inspection. Companies may also employ third party inspectors during outbreaks to determine the strength of prevention efforts. Legal firms and private investigators interested in understanding how these outbreaks occur, and why, increasingly conduct inspections during or after foodborne illness outbreaks (See WALB Article on PCA).
www.safefoodsblog.com/uploads/file/WALB Article.pdf
The Causes of Foodborne Illness
The key principle guiding the inspector is the understanding of the causes of outbreaks. Pathogens cause disease when they are present in sufficient numbers in food to produce an infection or intoxication. How they get into food and survive to the consumer depends on a series of related factors that the inspector must develop as the basis for his inspection techniques.
The Agent, the Host and the Environment
It is fundamental to understand the relationships between the host, the environment and the agent. The characteristics of the host or victim such as age and health status play a role in disease transmission. In addition to the vulnerability of the host, the victim must consume the food so there are logistic considerations about the host and his exposures. The location of the victim, the amount or form of the food consumed, and other facts about consumption and handling relate to whether the person will come in contact with the pathogen. Onset of illnesses and types of symptoms are particular to pathogens and help to provide confirmation of the agent at work.
The Environmental Route of Exposure
The environment plays an essential role in supporting the disease transmission pathway. Disease transmission through the environment occurs when a reservoir of the agent is present and exploits a means of spread. Since the organism in most cases is not motile, it needs a vehicle to get from its reservoir to the food. There it must survive and/or proliferate in the food product. Environmental conditions significantly affect contamination, growth of bacteria, and survival of any pathogen in the food.
Contamination, Growth and Survival
The act of contamination can occur through people, water, vectors such as pests, surfaces, and potentially through the air. Growth of the pathogen occurs when sufficient moisture and temperature are available to the organism for a sufficient time. Facts about the food itself and its ability to support microbial growth include its nutrient content, water content and level of acidity, as well as any processing aids used that influence growth. Survival of the organisms in the food or environment is dependent upon the surface available for colonization, cleaning and sanitary practices, and treatments used on the product such as cooking or pasteurization.
Etiologic Agents
Foodborne agents include over 200 known pathogens; bacterial pathogens that exist in a spore or vegetative cell, viruses, parasites, and toxins. The ability of the organism to survive environmental conditions depends on a number of factors, but Salmonella, Listeria, E coli O157:H7and several other pathogens appear to be hardy enough to survive for long periods, possibly months in ideal conditions. Some spore forming organisms such as Clostridium botulinum need anaerobic conditions to grow, and anaerobic conditions in product and packaging favor other pathogens as well. The reservoir of the pathogen is often difficult to discern. The value of environmental-microbial testing to inspection is that it can identify locations where the organisms have been harboring. Suspicious areas always include moist areas as well as surfaces receiving repeated exposure to dirt and environmental contamination such as floors and drains. There is always a possibility that incoming raw products continually seed the production environment with contamination. It is also possible that multiple reservoirs of the organism in the environment or in people lead to cross contamination throughout the production system.
The Inspection and Analysis
With the understanding of the pathway of infection and the complex relationships between the agent, host and environment, investigators apply an analysis of the food production process. Inspection is a process of observation and the inspector analyzes his observations to determine the likely exposures of the final product to contamination and to identify the process steps that allow proliferation and survival.
Analysis of Production
Food production processes start with the receipt of raw materials but the process at any one step in the food supply are interconnected with all other points right up to consumption. The inspector conducts a visual inspection of the structure, environment, equipment, layout and other factors while focusing on the production process.
Raw materials can contain the pathogen, and include packaging as well as the other ingredients ultimately used in the finished product. While visual observations may reveal potential problems, microbiological and other analysis may be necessary to determine the safety of incoming materials. It is safe to say the opportunity for contamination is significant in raw agricultural commodities grown in the soil and raw meat and other raw, animal foods.
Receiving is usually followed by storage although there may be some immediate use of products as they arrive Stored products may be subjected to hazardous environmental conditions such as pests, dirt, chemicals and foreign of objects Any moisture or signs of vermin where food or packaging is stored increases the risk for contamination.
Foods may be staged into production and be in various forms during processing. Since handling of products occur during production (or preparation), the human element becomes important as does machinery and equipment used, utensils, and the flow of foods through the process itself. Any point can lead to contamination or growth of bacteria if the process is not controlled. Cross contamination can occur when there is poor maintenance of food contact surfaces or under poor storage conditions.
Packaging occurs in food processing while service occurs at the retail level as the final step in the production process. Transportation is an intermediate step in the supply chain and can lead to contamination of finished products. Servers in food service environments can also contaminate foods that were otherwise safe to consume. The key is to analyze the entire food production process and avoid missing hazardous steps.
Evidence Gathering
Photographs, samples and other techniques such as interviewing provide additional evidence in the development of theories of causation and bolster the data obtained through the inspection process. The inspection findings may also benefit from a statistical approach and ranking of factors in terms of their significance and severity. A final report captures the data from all findings and often leads to a conclusion about how foods became contaminated.
Inspection during Foodborne Illness Outbreaks is an Essential Tool
Inspection as a tool in foodborne disease investigation is a critical part of preventing the further spread of pathogens. Inspections also lead to an understanding of the complex associations that influence the probability that a foodborne agent reached a product by a specific pathway. Inspections form a central piece in determining what went wrong and how to prevent similar outbreaks it in the future.
Inspectors should make it clear to operators that they must apply the outbreak inspection findings to the process under study as a matter of urgency and take corrective actions to improve it and other similar processes.
Whether or not an inspection is routine or occurs during or after an outbreak, the ultimate value of inspection in general is to improve the food supply. When applied in a very systematic fashion, inspections during foodborne illness outbreaks can move food safety efforts forward very effectively and dramatically protect the public in the future.

Recent statements by several experts about the legitimacy of third party audits are missing the point. Third party audits are far from Ponzi schemes. They act to protect the buyer when they are realistically representative of the safety of foods and the buyer uses then as a basis for buying decisions. If there is a major shortcoming, it is that buyers do not always adhere to the audit findings, and choose their suppliers on some other basis. Buyers on the other hand are obligated to get the products needed to sell at the retail level. We all need food, and the retail industry cannot stop supplying consumers every time there is a potential problem revealed in an audit. Buyers of food are not police officers empowered to cut off suppliers with questionable sanitation. On the other hand, reputable firms are blind when they purchase unsafe products that would have been very apparent if tested or a visit to the facility made.
As I have argued, apparently in vain, the lack of a foundation of food safety throughout the food supply is the real culprit, not the weaknesses of the third party model. There should be no one, not one firm operating without the oversight of a government agency enforcing minimum standards. As some have written, minimum standards are all we can expect from government, but that is a lot. Without them, its naïve thinking that the industry will “police” itself. That is not what industries do; they expect government to do this. One of the paradigms that must be broken is that getting rid of government inspectors and turning all food safety totally over to industry is the wave of the future. Industry associations have argued this and to an extent have short-circuited the food safety system, but they have been pretty quiet of late and these same associations are now calling for intensive oversight.
I believe very strongly in industry self control, but we need to realize that the way business works, that self-control will be stronger or weaker depending on the entities involved. Therefore I argue that we need both; we need a validated industry self control model and an effective governmental oversight model working in tandem.
What happened at PCA was deplorable but it is not the standard for the third party audit industry. Most auditors understand and report risks, they do not allow relationships that develop on the job to sway them. Many just go about their business politely and professionally, but still record the errors they see, there is a knack to doing this that we learn. The best auditing firms are very aggressive about not allowing inappropriate relationships to happen, sure, it does, but the best of us discourage it. Auditors are not just vendors that show up at a plant; that is something that industry must also come to realize.
As I have also written, I have faith that this is all working for the best, because basically I have faith in this country and its ability to rise above the obstacles, especially now that we have reached a “Jungle” experience again after 100 years.
Now with consumers, legislatures, media and government appalled by what happened in Plainview and Blakely I predict we will see a real partnership between industry and government. I also believe third party auditing firms will play an important role in bringing order out of the chaos.
In conclusion, once our government enforces basic sanitation throughout the food chain, third parties will be able to do what they do best, and that is separate the Good, from the Excellent from the Superior. It is ridiculous that there is even one firm operating in “Poor” or less capacity such as I observed at PCA. Third parties in reality should never see this. This is lax government oversight. Do not expect third parties to fix the poorest operating facilities, it is not their role, that role belongs to the public health community and fixing that problem will fix most others.