Outbreaks of foodborne illness occur frequently but some of them grab my attention more than others.

Take, for example, the Listeria outbreak still going on in South Africa, reasonably well understood, and now under litigation.

I’ve been tracking it by reading Food Safety News, following food-safety lawyer Bill Marler’s blog, and now keeping up with the class action suit filed in that country.

As of late March, the outbreak, which started in January 2017, has caused at least 982 cases of illness—and that’s just how many have been reported.

Of these, the final outcome is known for 70% (687 cases).  Among these, the death rate is distressingly typical for Listeria infections—28% (189 deaths).

The South African version of the CDC has produced an epi curve:

Note that products were not recalled until most cases were identified.  This outbreak was hard to solve.

Marler tweeted an Infographic on how the Listeria spread.

The good news: new cases are declining.

But in January this year, long before these figures were reached or the cause identified, the World Health Organization called this the largest Listeria outbreak ever recorded.

Its cause?  “Polony,” a ready-to-eat meat product produced by a company called Tiger’s Enterprise Food.  This company holds about one-third of South Africa’s $412 billion processed meat market.

A large number of meat products have tested positive for Listeria and have been recalled.  Tiger brands says cost of the recalls will be high.

More bad news:

Tiger Brands knew for at least a year that its polony had been contaminated with Listeria, but apparently even when warned in March that

listeria was rampant at its Polokwane factory, the Tiger Brands operation continued to churn out tons of potentially dangerous products, choosing to do only a  “silent recall” of one brand, Mielie Kip,  on February 14. The factory was shut down only last weekend, after the listeria strain was confirmed as being the deadly ST6.

South Africa had developed food-safety standards for the processed meat industry in 2014, but the industry blocked them.

Bill Marler has now teamed up with  Richard Spoor Incorporated Attorneys to file a class action lawsuit against Tiger Brands.

A forensic investigator plans to bring murder charges against the company.

One other interesting aspect is the suspected ingredient in polony:

Remember “pink slime?”  Meet “white slime,” a slurry of chicken part leftovers (bone marrow, bone fragments, cartilege, and even meat) thought to be the cause of the outbreak and imported from Brazil, no less.

Brazil, however, pleads innocent and says its products are not to blame.

Marler has offered some free advice to the CEO of Tiger brands, but it may be too late.

Stay tuned.

Last week, FDA Commissioner Scott Gottlieb spoke at the National Food Policy Conference in Washington, DC where he announced FDA’s Nutrition Innovation Strategy.

His speech, Reducing the Burden of Chronic Disease, specifies five areas that FDA intends to consider (meaning, at best, proposing suggestions for public comment and going through FDA’s interminable rulemaking process):

• Modernizing health claims
• Modernizing ingredient labels
• Modernizing standards of identity
• Implementing the Nutrition Facts Label and Menu Labeling
• Reducing sodium

The documents:

• Commissioner Speech: https://www.fda.gov/NewsEvents/Speeches/ucm603057.htm
• FDA Nutrition Innovation Strategy: https://www.fda.gov/Food/LabelingNutrition/ucm602651.htm

My immediate reactions: sounds good, but short on commitment.

I was impressed that Gottlieb focused on public health and prevention:

We can’t lose site of the public health basics – better diet, more exercise, and smoking prevention and cessation…The public health gains of such efforts would almost certainly dwarf any single medical innovation or intervention we could discover.

Yes!

I was particularly interested in two initiatives under consideration:

Front-of-package icon for “healthy”

This is to be based on a food-based definition that focuses on the healthful attributes of a food product—not, apparently, on its content of sugar, salt, or saturated fat.  Only healthful attributes?

This sounds like a highly pro-industry position, since research on front-of-package labeling is pretty clear that warning labels about unhealthful attributes (salt, sugar, saturated fat) are most effective in discouraging purchases of “ultraprocessed” foods.  The warning labels used in Chile, for example, are proving to be highly effective.

Gottlieb did not mention the the FDA-sponsored reports on front-of-package labeling performed by the Institute of Medicine early on in the Obama administration.  Those were serious attempts to develop an effective front-of-package labeling system that identified nutrients to be avoided.  The FDA seems to have forgotten about those reports.

Reduce sodium

This is the item that got the most attention.  Gottlieb said: “There remains no single more effective public health action related to nutrition than the reduction of sodium in the diet.”

OK, but if that’s true, how about ensuring that food companies gradually reduce sodium in their products, as was done in the UK.  No such luck.  Instead: “I’m committed to advancing the short‐term voluntary sodium targets” (my emphasis).

I suppose “voluntary” could work, but if sodium reduction isn’t across the board, companies will have little incentive to risk changing their formulas.

In short, Gottlieb’s words reflect modern public health thinking the good news) and it’s great that FDA is considering taking these actions (also good news).  Now, let’s see what the agency actually does.

USDA has just published its latest overview of US food assistance.

Here’s what this is about:

These percentages apply to total USDA spending on 15 domestic food and nutrition assistance programs: $98.6 billion in FY 2017.

The bottom line: expenditures are down and have been declining for the past 4 years.  $98.6 billion is 4% less than in 2016 and nearly 10% less than the all-time high of $109.2 billion set in FY 2013.

How come?

Note: The prevalence of food insecurity has not changed.

Although USDA attributes the drop to improvements in the economy, the prevalence of food insecurity has not changed.

Therefore, we have to ask: Could tougher eligibility requirements and application procedures have anything to do with this?

USDA has just issued a revision to its food dollar series—its graphic explanation of how the U.S. food dollar gets spent.

This tells us that 15.8 cents out of every food dollar goes to the producer; the rest goes for marketing.

Oddly, the USDA does not provide an updated illustration of the marketing components from its previous version in 2006:

What this tells us is that 80% of the cost of food is accounted for by marketing.

Don’t farmers deserve more?

Last week, New York Times reporter Roni Rabin wrote how the National Institutes of Health (NIH) solicited funding from alcohol companies to fund—and, distressingly, participate in the design of—a study of the effects of moderate drinking on heart disease risk.

This is not the first time Ms. Rabin has written about this study.  In July, she described the study and its funding.

Since then, she has apparently been busy filing FOIA requests and conducting further interviews.  These reveal that the NIH actively solicited industry funding and input into this trial.

The [NIH] presentations gave the alcohol industry an opportunity to preview the trial design and vet the investigators. Indeed, the scientist leading the meetings was eventually chosen to head the huge clinical trial.

They also made the industry privy to pertinent details, including a list of clinical sites and investigators who were “already on board,” the size and length of the trial, approximate number of participants, and the fact that they could choose any beverage. By design, no form of alcohol — wine, liquor or beer — would be called out as better than another in the trial.

But it gets worse.  Boston University professor Michael Siegel tells his personal story of dealings with NIH’s National Institute of Alcohol Abuse and Alcoholism (NIAAA)

On January 16, 2015, I was called into the office of the Director of NIAAA and was essentially reprimanded for conducting NIAAA-funded research that was detrimental to the alcohol industry…At the meeting, I was told that I would never again be funded to conduct research on alcohol marketing, regardless of how highly my research proposal was scored by the scientific review panel.

Let me be clear: research ethics require funders to have no involvement in research design, conduct, or interpretation, lest they exert undue influence on the results.

Julia Belluz (Vox) put this study in context.  She describes how

The NIH is now investigating whether the researchers violated federal policy by soliciting donations, and they’re appointing outside experts to review the design of the study. We don’t yet know the full story, and there’s surely more to uncover.

Anheuser Busch InBev, Heineken, Diageo, Pernod Ricard, and Carlsberg helped pay $67.7 million of the $100 million government study, which is currently underway. And even more troubling is that if you were a patient looking to enroll in the trial through the online clinical trials registry, you’d have no way of knowing about the industry’s involvement because that funding is not disclosed there.

Although I do not have much to say about the alcohol industry in my forthcoming book, Unsavory Truth: How Food Companies Skew the Science of What We Eat, I mention of this study as an example of how other industries skew research and also how pooling industry research funds is insufficient protection against conflicted interests (alcohol companies agreed to contribute 67.7% of the funding).

It’s good that the NIH has decided to investigate this dubious government-industry partnership, which so clearly seems aimed at marketing, not public health.

Last week, the New York Times published an article about how the US was inserting provisions in NAFTA negotiations to restrict the ability of Mexico to put warning labels—similar to those in Chile and other countries—on ultraprocessed “junk” foods.

Urged on by big American food and soft-drink companies, the Trump administration is using the trade talks with Mexico and Canada to try to limit the ability of the pact’s three members — including the United States — to warn consumers about the dangers of junk food, according to confidential documents outlining the American position.

The American stance reflects an intensifying battle among trade officials, the food industry and governments across the hemisphere. The administration’s position could help insulate American manufacturers from pressure to include more explicit labels on their products, both abroad and in the United States. But health officials worry that it would also impede international efforts to contain a growing health crisis.

In response to questions by Rep. Lloyd Doggett (Dem-Texas), US Trade Representative Robert Lighthizer argues that front-of-package labels are a form of protectionism.

Really?

A more compelling reason is that food companies are worried about the possible spread of front-of-package warning labels like those in Chile, Ecuador, and other countries.

I have a long-standing interest in front-of-package labels and wrote about opposition to the warning-label movement recently in a commentary in the American Journal of Public Health.

The Center for Science in the Public Interest (CSPI) issued a statement:

More countries, and certainly the United States, Canada, and Mexico, should give consumers easy-to-read front-of-package labeling that quickly communicates the information they need to avoid diet-related diseases…This is not an “America First” policy; it is an “Industry First” policy, conducted at the expense of the health of consumers in the U.S. and abroad.

Julia Belluz (Vox) describes the effects of a provision like this on Canada’s front-of-package labeling proposals.

Mexico’s outstanding food advocacy coalition, the Nutritional Health Alliance, argues that this pro-industry effort to block warning labels poses a serious threat to consumer rights and public health.

It held a press conference last week on this issue and has produced background documents (in Spanish, but it’s always fun to try Google Translate):

• Descarga anexo de etiquetados de advertencia aquí (examples of FOP labeling from the Americas region)
• Descarga nota jurídica en torno a la homologación de etiquetados EU-México aquí (legal commentary on how such treaties violate health and consumer rights and are illegal in Mexico)
• Descarga comunicado de prensa respectivo aquí (press release)

This comes from one of those daily food-industry newsletters I subscribe to, in this case NutraIngredients.com.  It occasionally focuses on regions and I thought this collection of articles was of interest.  Do Latin Americans need dietary supplements?  Just asking.

Welcome to NutraIngredients’ first quarterly supplement focusing on the Latin American dietary supplements and functional food markets. In this edition, we look at the changing regulatory landscapes across the region, including a deep dive into how Brazil is creating a distinct category for supplements. We’ll also look at a supplement start-up and opportunities for omega-3s in LATAM.

• More education will help realize huge potential for omega-3s in Latin America: Consumers in Latin America understand the general benefits of omega-3s. But there is a need for more education to help capture the huge potential for the ingredients in this region where the market is far from saturated… Read
• LATAM’s regulatory landscape: From Argentina to Uruguay: The regulations around dietary supplements in Latin America are a patchwork of different approaches, but regulatory bodies and regional associations are pushing for change and perhaps even some harmonization… Read
• Florida start-up CareMundi brings US supplements to Brazilian buyers: In the dietary supplement world, Brazil is notorious as being a tough market to get into. But there is demand for US-made products in the country, and one-year old start-up CareMundi, an online sales platform, is providing a bridge for US supplement makers into Latin America’s largest consumer market… Read
• Brazilian regs to be altered to finally create distinct category for supplementsNew regulations set to take effect in Brazil will significantly improve market access for dietary ingredients and finished dietary supplements, an expert says… Read  The possibility of incorporating the health benefits of probiotics into fortified fruit snacks could be a reality thanks to researchers in Brazil… Read
• Brazilian regulatory overhaul will benefit omega-3s, consultant saysThe outlook for omega-3s in Latin America is bright, according to a consultant experienced in the region. In particular, there is regulatory acceptance for these ingredients across the continent… Watch now

The Physical Activity Guidelines Advisory Committee’s 2018 Scientific Report promotes physical activity as a “best buy” for public health.

• Physically active individuals sleep better, feel better, and function better.
• Some benefits happen immediately.
• Physical activity reduces the risk of a large number of diseases and conditions.
• The benefits of physical activity can be achieved in a variety of ways.

The report recommends 50 to 300 minutes per week of moderate-intensity physical activity, but

• Any is better than none
• More is better than less
• Any amount at any level or duration counts.

The good news is that huge benefits come with just being somewhat active.

The report recommends 50 to 300 minutes of at least moderate activity a week, and this can be done in increments.

A brisk walk around the office, anyone?