Got Raw Milk?

Claire Panosian Dunavan is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Tropical Medicine and Hygiene.

What’s behind the risky allure of raw milk? Is it buyers’ faith in “nature’s perfect food” or sellers’ pure, naked greed?

I can hardly imagine Nathan Straus’s dismay were he living today. In the 1890s, when the wealthy retailer started a private foundation to dispense pasteurized milk, disease-bearing dairy was killing an estimated 25% of America’s infants.

Fast forward 30 years: by then, pasteurized milk was no longer a novelty, it was clearly saving lives. Consider the following facts from an article about Straus, which confirmed that: 1) from 1891 through 1925, mortality among U.S. infants dropped from 125 per thousand to fewer than 16 per thousand; 2) by supplying pasteurized milk to 297 “milk stations” in 36 cities, Straus personally saved 445,800 vulnerable children; and 3) Straus’s crusade for mandatory pasteurization indirectly prevented the deaths of millions more.

Regulatory change went hand-in-hand with growing enthusiasm for the heat-treated dairy. In 1908, after voluntary pasteurization of milk cut infant deaths in half, Chicago was the first city to require pasteurization of milk. New York City followed suit 6 years later. In 1948, Michigan enacted the first statewide mandate, and, in 1987, the FDA banned raw milk’s interstate sale or distribution.

Nonetheless, all these years later, certain producers and retailers still profit from selling raw milk to hardcore believers, aided and abetted by a strange patchwork of regulations and loopholes enacted by business-friendly legislators. Meanwhile, internet sales have fueled interstate commerce. In some cases, the risky product is then served to innocent children and other vulnerable hosts like pregnant women and grandparents.

What’s wrong with this picture?

Over decades, having seen many miseries stemming from microbe-tainted dairy consumed overseas, this question struck me anew while reading about three recent outbreaks right here at home.

U.S. Outbreaks Still Occur

Take, for example, a recent outbreak in California, where retail sale is legal but licensed sellers must label their wares, “WARNING: Raw (unpasteurized) milk and raw milk dairy products may contain disease-causing microorganisms.” In October, it was Salmonella linked to raw milk that struck 19 people in San Diego and Orange County, three of them youngsters who were hospitalized. Parts of the investigation are ongoing.

In this case, the producer was a successful, family-owned business previously known as Organic Pastures that now goes by Raw Farm LLC. Earlier this year, Raw Farm cheese or milk caused two other outbreaks, one due to Salmonella, the other to Campylobacter. Over previous years, after bad bugs sullied its “unprocessed, whole, and living” milk, the company’s products had already triggered eight other outbreaks and recalls.

October also brought twin flurries of Campylobacter in 17 people who purchased raw milk in Idaho and Utah. I subsequently read a Utah producer’s blog post entitled “3 Reasons to Drink Raw Milk (& 1 Reason Not To!).” Amazingly, in a state that, since 2009, has suffered 25 raw milk Campylobacter outbreaks, the “reason not to” was milk allergy as opposed to a serious, even life-threatening infection.

Dear Blogger: have you ever met a patient with bloody colitis caused by Campylobacter, much less someone paralyzed by Campylobacter-induced Guillain Barré syndrome whose life depends on a ventilator? And did you know that non-typhoid Salmonella typically tops the list as the leading worldwide cause of foodborne death?

Back to other troubling trends and statistics. How about our nation’s four-fold increase in raw-milk outbreaks from 2007 through 2012 compared to the preceding 13 years? And despite the fact that they comprise only 3% of U.S. residents, raw-milk consumers are 840 times more likely to suffer illness than their counterparts quaffing pasteurized dairy.

Nature’s “Perfect Food” Can Carry a Bevy of Bugs

Now for a quick historical overview of pathogens that happily grow in raw milk and can threaten people who drink it. During the pre-pasteurization era, some infections stemmed from cow milk’s human handlers (think, for example, of certain people carrying diphtheria organisms, group A strep, typhoid, or cholera), while Mycobacterium bovis (bovine TB) and Brucella were common zoonoses that often infected animals and tainted their milk before it was ever expressed.

In contrast, 95% of dangerous microbes contaminating raw milk in the U.S. today are Campylobacter and Salmonella, fecal bugs which can easily end up on udders and teats as well as milk barn equipment. The same route of contamination is true for E. coli and listeria, although these two fecal perps are less often implicated in raw milk-associated outbreaks.

Raw milk entrepreneurs often ignore or minimize these threats, sometimes arguing that other microbes in their products offer health-enhancing benefits. Simply put, public health experts disagree.

An Expert’s Take

Professor Darin Detwiler, LPD, MA.Ed, of Northeastern University, in Boston, is uniquely qualified to advocate for consumers, and not just because he’s an expert in food safety and food regulation. In 1993, during the seminal Jack in the Box outbreak, his 2-year-old son died of complications from an E. coli infection, contracted through person-to-person exposure, traced back to a contaminated hamburger.

Detwiler harbors few illusions about our current system’s ability to regulate raw milk. “It’s not just different state to state,” he recently told me. “We have some 3,000 jurisdictions. In some places it’s by city, other places by county or by state. Then you have tribal reservations, military bases, et cetera.”

“If the science shows there’s a problem with raw milk, and it clearly does — just look at the hundreds of outbreaks leading to thousands of illnesses, right? — it’s not like raw milk is different in one state than it is in another,” he continued. “In my view, it’s like saying one state should require seat belts and another should not.”

The ultimate problem, according to Detwiler, is educating policymakers, “…making them understand that the science doesn’t lie.”

“What about the vendors?” I felt compelled to ask.

As Detwiler sees it, they already know the truth. He believes that “Not one of these farms, stores, producers, whatever that sells raw milk is unaware that some people are harmed [by the product], but they continue selling it because they believe there’s an audience out there that will buy it. Until we change the culture and people say ‘Maybe we shouldn’t drink that…’ it’s not going to change.”

Do I believe that healthcare professionals can help spread the word and nurture that change? In a word, yes. But rather than preaching, perhaps we should start with the legacy of Nathan Straus, who also lost one of his own beloved children to an infection contracted from unpasteurized milk.

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