Scott Freeman, owner of Kiniker Dairy in Colorado.One of the most emotional issues around the anti-raw-milk campaign by federal and many state authorities is that of illnesses. I guess the question boils down to this: Should we believe the authorities, who are committed to shutting off the supply of raw milk, to investigate and analyze illnesses that may or may not be the result of raw milk consumption?

We now face this question with the recent issuance of a report by the Colorado Department of Public Health and Environment about the campylobacter outbreak last spring at Scott Freeman’s dairy. It’s something I’ve reported on previously, and which Scott Freeman refers to in a comment following my previous post.

I’ve spent some time reviewing the state’s documents, and I should say, I started off wanting very much to be highly critical. I do have criticisms, but I came away impressed with the thoroughness of the investigation as presented in the report. When I say that, I’m trying to allow for the fact that we’re not going to get a Presidential commission type of investigation—remember, we’re dealing with a public health department that has lots of reports of illness from restaurants and other places to look into, and must prioritize its work.

In this case, public health officials personally interviewed 159 of Scott Freeman’s 208 shareholders. I know some raw milk advocates will read all kinds of biases into the report, and certainly a number are present (which I’ll discuss). But after allowing for those (nearly a given when it comes to the public health community’s attitudes toward raw milk), the report is enlightening from both positive and negative perspectives.

On the negative side:

            –The number of people sickened was quite high, according to the report. It states: “There were a total of 81 cases identified in this Campylobacter outbreak… Thirty-one percent of all shareholder households reported at least one person with illness that met the case definition, which is a substantial attack rate.” When you consider that data from the U.S. Centers for Disease Control shows that in the period 1973-2005 there was an average of 54 illnesses per year, one outbreak of 81 cases is a lot. It’s important to note, as well, that only one of the illnesses was serious enough to require hospitalization.

–The department made a strong case that sanitation at the Kinikin Dairy wasn’t up to snuff. “The milking parlor was inadequately built/constructed shed which failed to meet the minimum standards prescribed in the Pasteurized Milk Ordinance or the Manufactured Milk Regulations, as well as the standards described on the dairy’s own raw milk website. The floor consisted of dirt and hay, and was soiled with manure. The interior was unfinished plywood, with openings directly to the outside around the door and other various points within the structure. Overall the structure was not clean nor in good repair. Animals other than cows (dog, chicken) entered the milking area during the visit. The milk room/house (storage area) was well constructed and had the minimum of equipment. There was evidence of manure being tracked into the milk house… There were no handwashing facilities in the milking parlor. Sanitizing solution was not used to sanitize the Mason jars used to bottle the milk, and on the day of inspection, there was no chlorine sanitizing solution present.”

–The investigation highlighted tensions between farmers and public health officials. Scott Freeman initially cooperated with officials. But when he continued to make milk available to shareholders after the Dept of Public Health and Environment requested he end sales, the department issued an order prohibiting distribution. He says he continued the distribution because shareholders requested he do so, and because they own the cows, he was obligated to do so. (Documents associated with the exchange between Scott Freeman and the department are contained in an appendix.)

–The department never found campylobacter in the dairy’s milk. Would that it were so straightforward.It found evidence of campylobacter via a PCR test (polymerase chain reaction, which identifies genetic material from campylobacter), but noted that such tests were not part of its usual protocol, and therefore not conclusive in and of themselves. Further complicating the situation, according to the report, the testing of milk samples was limited, apparently because of the department’s own screwups in handling milk testing samples. “Three additional milk samples were collected on April 22, May 1 and May 6 but were rejected by the laboratory because they were not delivered in the necessary time frame or did not have documentation that they were held at the correct temperature during transit, which is required for formal regulatory milk testing, although is often not required during outbreak investigations.” It would have been intriguing if those three additional tests had shown no evidence of campylobacter. It seems as if the public health people were sloppy in their handling of the samples, which isn’t comforting, given the public health hazard.  Inference was the order of the day—based on the prevalence of raw milk drinkers among those with campylobacter, officials concluded raw milk was the culprit. (I think the public health officials make an important point that campylobacter isn’t easy to pinpoint in any food.)

–The department’s negative attitude toward raw milk pervades its conclusions: “Unpasteurized milk has been the source of numerous outbreaks in the past, in Colorado and other states. Another Campylobacter outbreak associated with unpasteurized milk from a cow share operation occurred in Larimer County in 2005. Outbreaks of Salmonella, E. coli O157 and Listeria associated with unpasteurized milk have been documented in other states and have resulted in deaths and cases of hemolytic uremic syndrome. Fortunately this outbreak involved only one hospitalization and no deaths. With the increasing number of cow share programs, outbreaks associated with unpasteurized milk are likely to continue in Colorado.” “Numerous” outbreaks in Colorado, yet all it can come up with is one, four years previous? And “resulted in deaths”?  Like any number of governmental authorities, it makes this assertion, even though there aren’t any known deaths from raw milk since at least the 1980s.

On the positive side:

–The department made recommendations to Scott Freeman to improve his sanitation. As I noted earlier, it concluded that sanitation was lacking at the milk parlor. So the department recommended installing hand-washing facilities and improving washing of equipment and bottles to improve sanitation, and he adopted the suggestions. Isn’t education part of the public health department’s role in life?

–One of the most interesting pieces of data from the public health investigation is a survey of the shareholders’ reasons for drinking raw milk. Perhaps not surprisingly, it is buried in the reports (table 7 of Appendix 2), rather than highlighted. It shows the two most popular reasons being that it’s more nutritious and better tasting (than pasteurized milk), with substantial numbers saying raw milk helps relieve their allergies, improves their immune systems, and enables them to overcome lactose intolerance. There aren’t many such surveys around–it’s useful information that helps document why so many people are willing to take whatever small risk might be involved to consume raw milk.

One of the messages that comes through loud and clear from the report is that investigations of food-borne illness are as much art as science. It’s a form of detective work. As a result, when I read a report like this, covering 81 illnesses, and then see the repeated invocation of the mantra that we have 76 million cases of food-borne illness each year, it’s hard not to be skeptical. The only way to characterize that 76 million number is as a wild estimate, and it underlies the current push for draconian limitations on food producers being proposed in the current food safety legislative push.

I’ll be curious to read Scott Freeman’s take. I know he disagrees with a number of conclusions, most importantly, the one that lays the blame for the campylobacter outbreaks on his dairy. He may have good arguments, but I sense in all this that the public health professionals made a good-faith professional effort to figure out what might have gone wrong at his dairy, despite their own biases. It’s a situation everyone can learn from, and hopefully that’s what will happen, as opposed to ongoing recriminations.