Perceptions About Raw Milk Consumption. Milk Consumption Although milk is not universal, it is one...

Perceptions About Raw Milk Perceptions About Raw Milk ConsumptionConsumption

Milk ConsumptionMilk Consumption

Although milk is not universal, it is one of the most widely consumed foods that humans get from other animals [get map from harris chapter]

Evolutionarily, milk is a complete and well balanced food for infants of the species that biological verity has been extended to a view that milk is “the ideal food for humans, particularly to sustain growth in children, fetal growth in pregnant women, and milk production during lactation” and that “nature’s most perfect food”

Milk ConsumptionMilk Consumption Historically, milk was drunk raw or preserved Raw milk sours because of natural lactobacilli Cultures that drank milk dealt with spoilage and

long term storage in several ways– Consumed immediately or boiled for later use – Yoghurt, cheese, buttermilk, sour cream

Possibility of acquired immunity to zoonotic pathogens through care of farm animals

Pasteurization has two functions– Kills spoilage organisms that sour milk– Kills pathogens that can cause serious illness

Traditional View of Milk Traditional View of Milk Practiced in Bangladesh TodayPracticed in Bangladesh Today Dairying is practiced in Bangladesh as a

part of local crop livestock farming systems, typically involving involving one or two animals and half an acre of land

The cows are mostly maintained as bull mothers and to produce a little surplus of milk (0.5–1.5 liters daily) for household consumption

Some fermented milk products, such as yogurt, cheese, buttermilk, and sour cream, are produced by traditional methods

Origin of Microbial ContaminantsOrigin of Microbial Contaminants

At the point of milking, microorganisms in milk come from animal body surfaces, feed, air, water, and utensils and equipment used for milking and storage

The main causes of increased bacterial count during transportation of milk are contamination due to inadequately cleaned vehicles

There are also occasionally pathogens in the teats, e.g., Mycobacterium bovis (tuberculosis), M. johnei (paratuberculosis), S. aureus (mastitis)

Contamination of Raw MilkContamination of Raw MilkThe main causes of increased

bacterial count during transportation of milk are contamination due to inadequately cleaned vehicles

Inclusion of milk from a single farm with high bacterial counts can have a significant event on the total colony count of tanker milk as well

Some Raw Milk-related related Outbreaks from 2000-2002 Outbreaks from 2000-2002

Year

Location Source Casual agent Number ill

2002 Edmonton Raw milk Campylobacter

5

2001 Wisconsin Raw milk Campylobacter

75

2001 British Columbia

Goat’s milk

E.coli O157:H7

3

2000

Austria Raw milk Campylobacter

38

PasteurizationPasteurization Pasteurization involves the heating of milk to a

temperature of 71.7oC for a period of 15 seconds (or for a similar combination of temperature and time)

Most milk sold in developed countries is pasteurized

Farming families are typically exempt A relatively small number of people defend their

right to drink raw (unpasteurized) milk Therefore, most European countries and more

than half of the U.S. states allow the sale of raw milk even if the volume is very low

PasteurizationPasteurization

Part of broader movement for public health and liberal welfare state

Pasteurization is incorporated into food regulations in UK, other European countries, Canada, U.S.

Current Federal Regulations Current Federal Regulations and Policy in theand Policy in the United United

StatesStatesUnited States restricted the sale of

raw milk products since the 1940s U.S. Department of Health and

Human Services banned the interstate shipment of raw milk in 1986

Current Federal Regulations Current Federal Regulations and Policy in theand Policy in the United United States - FDA and CDCStates - FDA and CDC

The health risks associated with the consumption of raw milk far outweigh any benefits derived from its consumption.

There are numerous documented outbreaks of milkborne disease involving Salmonella and Campylobacter , E. coli O157:H7, Listeria monocytogenes , Salmonella and Yersinia enterocolitica infections directly linked to the consumption of unpasteurized milk in the past 20 years

Current Regulations in Current Regulations in FranceFrance In France, the sale of raw milk destined for human

consumption is authorized but strictly controlled by a ruling of the Ministry of Agriculture of 1985, which provides for different levels of restrictions. unblemished record of no brucellosis and tuberculosis

(annual tuberculin testing) strict hygienic conditions regarding local equipment

(accommodation, local storage of milk), animal husbandry, good practice, cooling of milk, and cleaning/disinfection of material

well maintained register of the health of individual consignments and identification of livestock

Current Regulations in Current Regulations in FranceFrance

Raw milk is a category of "foods that have not undergone decontamination treatment or are susceptible to recontamination after treatment“– Listeria monocytogenes will be absent

at the time of production, and not exceed 100 organisms per gram at the time of consumption

The Alternate StoryThe Alternate Story

The Case For Untreated Milk The Case For Untreated Milk by Dr. B. M. Pickard, The by Dr. B. M. Pickard, The

University of LeedsUniversity of Leeds “There is no doubt that heat-treatment

[pasteurization] is detrimental to milk Evidence shows that untreated milk has a higher

nutritional value providing more available vitamins and minerals than pasteurized milk

It contains anti-infective agents which can both restrict the growth of contaminating bacteria in the milk and give the consumer protection

Not at least, it has a better flavor, with none of the deterioration in quality caused by heat treatment.”

Capital Press, the Pacific Capital Press, the Pacific Northwest’s Premier Agricultural Northwest’s Premier Agricultural

Newspaper, May, 2004Newspaper, May, 2004 “The increasing concentration of the dairy industry

is leading to the demise of small family-owned dairy farms and the domestic dairy industry, said dairy farmers from around the nation who met with New York Attorney General Eliot Spitzer

The dairy farmers, who came from throughout the Northeast and as far away as Wisconsin and California, called on Spitzer to take the national lead and begin investigating industry consolidation in New York for possible antitrust violations.”

The Association Fromages The Association Fromages de Terroir, Francede Terroir, France

“At least 50 cheese varieties have disappeared in the past 30 years and many more are on their way out

EU regulations are strangling the production of cheeses made with unpasteurised milk

"Pasteurising makes for bland and mediocre cheese, but because of unfounded hysteria over bacteria such as listeria, which is not dangerous except to particular vulnerable groups, we are killing a fabulous product."

Weston A. Price Weston A. Price Foundation PromotesFoundation Promotes Raw Raw

MilkMilk This bases its reputation on the

teachings of Weston A. Price, a dentist working in Cleveland in the 1930s who claimed that raw milk is healthier. dentist who visited 14 cultures and studied the impacts of their traditional diets

The Weston A. Price Foundation is lead today by Nancy Fallon, a frequent speaker at organic conferences and other holistic health and alternative agriculture events


MilkMilkShe says “Both raw and

pasteurized milk harbor bacteria, but the bacteria in raw milk is the healthy bacteria of lactic-acid fermentation while the bacteria in pasteurized milk is the bacteria of spoilage.”


MilkMilk This is vehemently disagreed with by

Dennis Avery who is a senior fellow for Hudson Institute in Indianapolis and the Director of the Center for Global Food Issues. He was formerly a senior policy analyst for the U.S. Department of State

He is opposed to any organic or natural food group because he feels there claims are not justified

California Court Ruling Against Alta Dena Dairy

The Superior Court found in 1989 that: – (a) "overwhelming evidence proved

that Alta-Dena's raw (unpasteurized) milk frequently contains dangerous bacteria that can cause serious illness";

– (b) the company must stop its false advertising - selling and promoting raw milk as healthier

The National Health Council Against Health

Fraud"The evidence is clear. Milk is a "The evidence is clear. Milk is a

wholesome food, but there is nothing wholesome food, but there is nothing to be gained from drinking it in its to be gained from drinking it in its raw, natural form. (Raw milk) poses raw, natural form. (Raw milk) poses a serious health risk to significant a serious health risk to significant segments of the population. Only segments of the population. Only pasteurized milk should be sold for pasteurized milk should be sold for general public consumption."general public consumption."

Public Health Veterinarian Public Health Veterinarian Coalition Committee Coalition Committee

Recommends that only pasteurized milk/products be consumed or sold– Many human pathogens have been

documented in raw milk (e.g., Salmonella, Campylobacter, Yersinia, Listeria, Brucella, E. coli).

– Consumption of raw milk products has been identified as an important risk factors for E. coli 0157:H7.

– Pasteurization of milk/products prior to sale is not required in all states

WWisconsin isconsin Cow Leasing Cow Leasing Program EProgram Ended in Illness nded in Illness

Since the sale of unpasteurized milk is illegal in Wisconsin, farmer Tim Wightman of Hayward sold shares in his cows, so the milk “belonged” to the share owners

Wisconsin organic dairy farm has been forced to end a complex “cow-boarding” scheme that enabled 250 “shareholders” to get otherwise-illegal raw milk—but not before 70 people were sickened by Campylobacter

OntarioOntario Rules Against Rules Against Cow Cow Leasing ProgramLeasing Program

Ontario government to allow farmers to drink unpasteurized milk while claiming that it would endanger public health for consumers to do the same

Ontario Board decided against “lease-a-cow” program, where consumers paid them for an animal's feed and upkeep, and in return gained access to raw milk and milk products

OntarioOntario Rules Against Rules Against Cow Cow Leasing ProgramLeasing Program

One farmer pleaded guilty to charges of selling unpasteurized milk– he was fined $3,500 and ordered to

dismantle the dairy operation within 30 days

– almost immediately, the insurance company cancelled the Schmidts' liability and fire insurance, and no other company would take them on.

– caught in an impossible situation, they were forced to sell their herd

The QuestionThe Question

Is this position is still valid for an industrialized world where there is ample supply of relatively cheap milk and we have the ability to eliminate infectious foodborne disease?

Or do we let a small group of people have the choice of a product they want whether or not there are good scientific arguments for it?

Some PerceptionsSome Perceptions

Regulation of Milk Sanitation Is Regulation of Milk Sanitation Is Contested (Ten Eyck, 2004)Contested (Ten Eyck, 2004)

Claimed advantages of pasteurization– Reduce mortality and morbidity– [do we know much about m/m due to milk @ 1900]– Delivered in sanitary containers from licensed dairies– First step toward large scale dairy farms, dairies, and dairy

industry Others claimed disadvantages

– Destroys some of nutritional values (vitamins)– Diminishes organoleptic values– Makes it very difficult for farmers to sell their own milk to

consumers– Makes it difficult for farmers to form dairy cooperatives to

sell their own milk

Population Surveys in Population Surveys in England and WalesEngland and Wales

England and Wales decided to conduct a survey of its population on a ban on raw milk consumption as recommended by the UK government through its advisory committee

5,000 such responses were received in England 500 responses were received in Wales from

consumers and producers objecting to the proposed ban– Only 20 responses in England and 2 in Wales supported

the proposed ban– Most of the responses supporting a ban were from

public health professionals

Association of Association of Unpasteurized Milk Unpasteurized Milk

Producers and ConsumersProducers and Consumers • Evidence shows that heat treatment has

detrimental effect on taste and on nutritional value • More work is needed on effect of heat treatment

on allergic reactions • That untreated milk contains anti-infective

agents which protect against infectious disease, and that these are destroyed by heat-treatment

• That untreated milk is sometimes wrongly blamed for outbreaks of foodborne illness, and that other foods are far more likely to be the vehicle of infection

Association of Association of Unpasteurized Milk Unpasteurized Milk

Producers and ConsumersProducers and Consumers • That pasteurized milk can be

contaminated with pathogens • That the way ahead is not to ban, but to

ensure that untreated milk contains the lowest possible levels of bacteria, and that it has been proved that farmers can produce clean milk. Therefore, though it is reasonable to penalize those with poor hygiene standards, it is wrong to suggest that all milk should be heat-treated because of these isolated outbreaks

Campaign for Real MilkCampaign for Real Milk • Retail raw milk of higher quality than much

milk sent for pasteurization because of controls on production

• Accepts presence of pathogens but claims infection from these minimal, and that raw milk carries beneficial anti-microbial agents

• Various health claims for raw milk, including higher vitamin content than pasteurized milk, immune system-strengthening enzymes, and reduced allergenicity, and argues that there are health concerns associated with heat treated milk (such as bowel disorders)

Campaign for Real MilkCampaign for Real Milk

Has legal advice that a ban would be �contrary to EU law, and that current controls may also be incompatible with EU law

States that in the event of a ban, �consumption of imports and milk from ‘house cows’ would increase, increasing the risks to health

Opposes a ban and supports better �labeling option, but would want to see claimed health benefits also included

United KingdomUnited Kingdom

EU legislation allows national rules prohibiting or restricting the placing of the market within its territory of raw milk or raw cream intended for direct human consumption

The vast majority of milk consumed throughout the UK is pasteurized

Each UK country has a different approach– Scotland has a total ban– England and Wales and Northern Ireland allows

some raw milk consumption Surveys reopened issue

UK ADAS Survey in 1995/96UK ADAS Survey in 1995/96

Of 1591 samples, over 60% of the samples taken contained indicators of faecal contamination

In addition, 7% of samples contained Staphylococcus aureus, 2% contained Listeria monocytogenes, and one sample contained Salmonella

Another study detected Campylobacter in 6% of a total of 985 samples

The Public Health Laboratory The Public Health Laboratory Service (PHLS) Survey Service (PHLS) Survey

1996/19971996/1997Of 1132 raw milk samples, 3.7%

contained various pathogens including E.coli O157 (3 samples), Campylobacter (21 samples), and Salmonella (5 samples)

UK Advisory Committee on UK Advisory Committee on Microbiological Safety of FoodsMicrobiological Safety of Foods

In 1997, the ACMSF expressed concern that the surveys showed that raw cow drinking milk carried significant amounts of micro-organisms indicative of fecal contamination, as well as, in some cases, foodborne pathogens

The Committee concluded that the sale of such milk in England, Wales and Northern Ireland should be banned, as it already was in Scotland

Organic Associations and Organic Associations and FarmersFarmers

• Frustration at further consultation so soon after the result of the previous exercise, with no reason to believe opinion has changed

• States risks have reduced since controls strengthened

• States that presence in milk of microorganisms indicative of fecal contamination does not necessarily indicate a health risk, and that pasteurization destroys, nutrients, enzymes and other anti-bacterial mechanisms as well as pathogens

Organic Associations and Organic Associations and FarmersFarmers

Notes belief held by some that homogenization �associated with increased risk of heart disease, though notes that evidence is inconclusive, and that unpasteurized milk is one of the few choices available to people who want ‘non-homogenized milk’

A ban would drive sales underground, increasing �the risk, and would damage organic dairy producers

Believes in freedom of choice, and states that �unpasteurized milk contains more vitamins than pasteurized, and also contains microbes that build immunity

Organic Associations and Organic Associations and Farmers Farmers

• Argues that figures on foodborne illness show that milk (including unpasteurized) is safer than many other foods (such as burgers, eggs)

• States that strict controls already apply to unpasteurized milk, suggests that if there is a problem with individual producers, powers exist to tackle them

• Believes that this should be considered in wider context of the impact of intensive farming methods which create many potential health problems, and that FSA should be promoting alternatives to such methods

Arguments Counter the Raw Arguments Counter the Raw Milk AdvocatesMilk Advocates

Freedom of choice is a political, philosophical or emotional matter that largely ignores the evidence of hazard and risk

Appreciation of risk is often poor among the public, even among those who are especially susceptible (Heathcock et al 1998)

There is loss of some nutritional factors but these are readily available from alternative sources in the normal diet, without the need for supplementation (Potter et al 1984)

Perceptions for Drinking Raw Perceptions for Drinking Raw MilkMilk

• It tastes better than pasteurized milk which is bland and has much goodness removed

• Knows where it comes from (local supplier), and values its traceability

• Pleased that it is tested regularly • Wishes to retain freedom to choose approved

retail raw milk (green top) • Values freedom to be able to choose an

alternative • Purchases from local supplier, values

traceability this offers


• Believes green top builds immunity, and argues that there is evidence that overprotecting makes us more susceptible to germs and to allergies

• Accepts there is a risk but believes it to be insufficient to warrant a ban

• States the market is small, those who consume unpasteurized milk choose to do so understanding the risks involved


Travels to buy organic untreated milk (objects �to term ‘raw’) and cheese – says it is organic, better quality and the source is known

Argues that heat treatment will eventually �lead to emergence of heat resistant pathogens (compares to emergence of superbugs in hospitals)

Sees main issue as freedom of choice – supply �already very restricted, and consumption could never be stopped completely

What Are the Arguments What Are the Arguments in Favor of Raw Milk?in Favor of Raw Milk?

These are primarily:– · the perceived organoleptic superiority

of the raw product;– · health and nutritional benefits (that

heating destroys beneficial nutrient factors);

– · that raw milk has inherently improved keeping quality or anti-bacterial properties;

– · freedom of choice

De Louvois & Rampling. De Louvois & Rampling. Brit Med J 1998Brit Med J 1998

"If the cow had been designed with HACCP for the dairy industry in mind it is unlikely that the udder would have been placed where it is."

Availability of Raw Milk – Availability of Raw Milk – Where Do We Go from Here?Where Do We Go from Here?

Are these the choices?– Total ban– Unlimited access to raw milk– Controlled raw milk supply with herd testing– Retail sales with labeling and education

indicating the risks– Shared/leased cow supply permitted– Farmers’ families only

Recommendations for Control Recommendations for Control of Raw Milk Consumption in of Raw Milk Consumption in

ScotlandScotland Scotland: A ban was introduced in 1983

because of illnesses associated with raw milk– between 1970 and 1982 some 3,500 consumers

were affected in 50 outbreaks of milk-borne Salmonella infections from raw milk with 12 fatalities

extend current total ban on raw cows drinking milk to ewe, goat and buffalo milk

Recommendations for Control of Recommendations for Control of Raw Milk Consumption in Raw Milk Consumption in

EnglandEnglandEngland: allows raw milk sales only

from registered milk production holdings (at the farm gate or in a farmhouse catering operation) or by distributors and milk roundsmen consumption and a label:– “This milk has not been heat treated and

may therefore contain organisms harmful to health”

Recommendations for Control Recommendations for Control of Raw Milk Consumption in of Raw Milk Consumption in

WalesWales Instead of a ban, tighter controls, including stricter

labeling – This milk/cream has not been heat-treated and may

therefore contain organisms harmful to health. The Food Standards Agency strongly advises that it should not be consumed by children, pregnant women, older people

In addition, more frequent inspection and microbiological sample testing– Official microbiological sample testing at production premises

now takes place four times per year and official inspections of registered raw cow milk production holdings take place at least annually

14 15-16 association statements against raw milk17-18 price foundation supports raw milk19 dennis avery statement [I would drop this; avery is a notorious industry shill]20 wisconsin cow leasing scheme ended in illness [but leasing continues in wisconsin, so need to separate general arrangement from specific occurrence of illness]21 ontario policy: allow farmers to consume, not allow cow leasing22 ontario enforcement puts farmer out of business23 eu and uk policy [I would make a separate slide for the eu]24-25 uk surveys of microbial contamination26 uk advisory committee recommend ban27 survey of public opinion in england/wales overwhelming support raw milk28-37 raw milk associations outline benefits [should these not be up with 17-18]38-40 perceptions of raw milk [not clear where these come from; is this our summary of 28-37]41-42 arguments for and against47 future choices

Historically, milk was drunk raw or preserved Raw milk sours because of natural lactobacilli Cultures that drank milk dealt with spoilage

and long term storage in several ways– Consumed immediately or boiled for later use – Yoghurt, cheese, buttermilk, sour cream


Outcome of ContestationOutcome of Contestation Only retail sales are regulated not farm family

consumption But some U.S. states, and European countries allow sale

of raw milk but regulate farm production conditions Some states allow consumers to own part of a cow, and to

receive milk from their part of the cow Norway allows farmers to make raw milk cheese because

cannot deliver milk to dairy during winter In every country a percentage of consumers demand

access to raw milk depends on how agrarian the country is controversy extends to cheese made from raw milk– U.S. regulations allow raw milk cheese if aged more than 60

days

France allows if dairy farm meets sanitary standards Queso fresco popular in Latino/Hispanic culture

Bangladesh and other developing countries provide current examples of some aspects of historical system– Need male cattle for traction for agriculture and transportation– Surplus milk from bull mothers can be consumed by humans

Vary in terms of how much meat want to harvest from the system

Only parts of tropical regions provide grassland to support surplus milk production, e.g., Kenya

Raw milk and its products raise a set of questions for progressive industrial and post-industrial societies

What is the proper role of the state in protecting consumers from foodborne illness

1) susceptible subpopulations 2) subpopulations lacking adult decision

making capacity 3) technological capacity in the society 4) supply of the relevant raw material

What Criteria Should Guide What Criteria Should Guide the State in Choosing the State in Choosing

Specific Instruments to Specific Instruments to Accomplish Accomplish

Its Policies (Proscription, Its Policies (Proscription, Inspection, Education)Inspection, Education)

What latitude should be allowed to consumers to choose foods that are – 1) relatively hazardous– 2) more hazardous than they have to

be

How Should a Society How Should a Society Make These Decisions?Make These Decisions?

Possible criteria– 1) science– 2) risk analysis– 3) benefit-cost analysis– 4) reversibility (e.g., sunset provisions)– 5) values

These questions could form the basis for an entire session in their own right . . . in our presentation today we will focus on consumer perceptions and attitudes concerning raw milk

Both raw milk and pasteurized milk are sources of foodborne illness

Although milk is not universal, it is one of the most widely consumed foods that humans get from other animals [get map from harris chapter]

Evolutionarily, milk is a complete and well balanced food for infants of the species that biological verity has been extended to a view that milk is “the ideal food for humans, particularly to sustain growth in children, fetal growth in pregnant women, and milk production during lactation” and that “nature’s most perfect food”

Historically, milk was drunk raw or preserved Raw milk sours because of natural lactobacilli Cultures that drank milk dealt with spoilage

and long term storage in several ways– Consumed immediately or boiled for later use – Yoghurt, cheese, buttermilk, sour cream


Origin of Microbial ContaminantsOrigin of Microbial Contaminants

The national dietary surveys do not have data on consumption of pasteurized and raw milk separately

The number of outbreaks attributed to raw milk in countries reporting such diseases is very small but that is partly because the consumption of raw milk in those countries is very small and would normally only affect a few people from one or two cows

Possibility of acquired immunity to zoonotic pathogens through care of farm animals

[picture from europe of two story farmhouse] Pasteurization of milk developed in mid 1800s

Time-temperature combinations allowed destruction of Mycobacterium tuberculosis and other pathogens

Pasteurization gradually spreads through industrialized, urbanized western societies although not used universally in any country including France

Traditional View of Milk Traditional View of Milk Practiced in Bangladesh TodayPracticed in Bangladesh Today Many policies exist to increase milk

production throughout the country, through government dairy farms or private dairy farms

The main objectives of these policies are to distribute raw milk at lower cost and to provide calves at marginal cost to poor farmers interested in rearing dairy animals

Traditional View of Milk Traditional View of Milk Practiced in Bangladesh TodayPracticed in Bangladesh Today

It is well known that milk is an ideal food for humans, particularly to sustain growth in children, fetal growth in pregnant women, and milk production during lactation

It has also been described as nature’s most perfect food

For the newly born infant or animal, mother’s milk is a complete and well-balanced food

Farmhouse Cheese Farmhouse Cheese ProducerProducer

•Believes in freedom to choose to consume foods beneficial to good health

•Believes pasteurization is linked to heart disease

•Notes that France, where unpasteurized milk is more widely available, is one of the healthiest countries in the world

•Believes a ban would damage the image of Wales as a quality food producer

British Goat SocietyBritish Goat Societyand Producersand Producers

• Argues that pasteurized milk can also cause illness; at least unpasteurized milk carries a warning

Also states that pasteurization reduces nutritional benefits of milk

• Small scale producers cannot afford pasteurization equipment, but their product is valued by local consumers

British Goat SocietyBritish Goat Societyand Producersand Producers

States outbreaks associated with raw �goats’ milk are believed to be miniscule, and that properly produced goats’ milk should not require pasteurization

Is opposed to a ban on retail sale, �believes current warning is adequate but

would accept better labeling, as they themselves advise pregnant women not to

consume raw goats’ milk

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