Index Case: Raw Milk
"It's like they think anything natural has to be better," exclaimed Tom Ward, NEHA Region 7 vice president and public health preparedness coordinator for Union County, North Carolina. Ward was voicing dismay over a small but apparently growing segment of the public who prefer to drink their milk "raw," or unpasteurized, because they consider raw milk nutritionally superior to pasteurized milk (Associated Press, 2008). Or they believe it's an important source of beneficial bacteria. Or they find that pasteurization destroys the flavor.
"I don't understand why someone would put more value on the taste of something than on the potential harm it can cause," commented Terry Pierce, director of the Division of Environmental Health in the North Carolina Department of Environment and Natural Resources.
The potential for harm has been well documented. Decades' worth of data show that raw milk has repeatedly been a vehicle of dangerous microbes such as Brucella, Campylobacter, Escherichia coli, Listeria, Salmonella, and Mycobacterium bovis, a rare form of tuberculosis (Aleccia, 2008; Austin et al., 2008; Food and Drug Administration (FDA), 2004; Harrington. Hayward, Archer, Davis, Croft, & Varma, 2004; Holt et al., 2003; Ward, 2008; Weisbecker, A., 2007). M. bovis has cropped up in the San Diego area in association with unpasteurized milk and dairy products (e.g., homemade cheese sold by street vendors), and it is resistant to the antibiotics normally preferred for treatment of tuberculosis (Aleccia).
Nevertheless, the issue recently came to the fore in North Carolina. Currently in that state, the sale of raw milk for human consumption is not legal. But advocates approached a state legislator, who has sponsored legislation legalizing "cow shares." Called the "Small Dairy Sustainability" bill, this legislation would allow consumers to collaboratively buy a cow and pay a farmer to care for it, and thus to "own" a portion of the raw milk it produces. As of this writing, in August 2008, the bill is still with the North Carolina Senate Committee on Agriculture, where it was referred on May 29, 2007.
Ward called JEH's attention to the very dominant presence that raw-milk advocates have established on the Internet. Their Web sites, he said, often "look scientific," but they abound with fallacies. Indeed, some of the reasoning on these sites is egregious. Under the heading "Raw Milk Safety," for instance, the blog Living the Slow Life in North Carolina, states:
The FDA estimates there are 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths per year from foodborne illnesses. ... The majority are caused by contaminated produce, 38%. ... ALL dairy--pasteurized and raw, accounts for less than 1% of these illnesses. (Foster, 2007) Well--to argue the obvious--yes. But then the vast majority of dairy products sold in this country are pasteurized (Headrick et al., 1998). So in what way do FDA's numbers reflect the safety of raw milk?
At the request of environmental health professionals in North Carolina, a working group of NEHA members reviewed the issue and composed a position statement opposing the legalization of raw-milk sales, the distribution of raw milk through barter or cow-sharing arrangements, and "any other action that would allow the consumer to obtain a portion of the production of raw, unpasteurized milk from a bovine, ovine, or caprine animal" (NEHA, 2008).
This article raises the raw-milk issue not to re-open that debate, but to reflect more broadly on the way the public reacts to the authority of health officials. The issue provides an example of resistance to "the science." And it is a striking example, given how sturdy the evidence is that drinking raw milk is dangerous.
It's also important to note, as did Pierce, that most members of the public buy pasteurized milk. They don't think twice about it. But the dissent has gained some traction in the media. And the dislike of technological intervention is echoed in many ways, on many other health issues, in mainstream public discourse.
Some Lay Perspectives on Raw Milk
To get a sense of how dissenting members of the public might be thinking, JEH contacted 17 acquaintances who had no professional association with environmental health. The selection process was not random. In fact, the respondents were chosen precisely because JEH knew or suspected that they had an interest in "natural" or "alternative" approaches to diet and health. Five people gave in-depth responses: a schoolteacher, a non profit program director, a software developer, a bookseller, and a retiree. Some of these conversations took place over e-mail, some by telephone. The purpose of this exercise was not to conduct a scientific survey, but to provide in-depth access to the voices of some nonscientists in order to more concretely delineate the terms of the discussion.
For most respondents, pasteurization was a non-issue. A typical comment came from Dorrie Lieman, a teacher:
I'm not ready to drink raw milk. Pasteurized milk--there's long-term evidence of its being okay. Note the reasoning: Acceptance is based on an accumulation of evidence over time. In this, it resembles the public health argument against raw milk. But the emphasis is reversed. Lieman focused on the safety of the intervention, rather than the safety (or lack of it) of the product in its natural state. That distinction is worth keeping in mind in light of the public resistance that is so common when public health officials declare "there is no evidence that" some intervention (pasteurization or fluoridation or vaccination, for instance) causes harm. As Alan Leshner, CEO of the American Association for the Advancement of Science, has argued, scientists have often responded to skepticism by trying to "educate" the public--issue by issue. That approach is not working because "many science skeptics are quite well educated, but they relate more to the risks of science and technology advances than to their benefits" (Leshner, 2003, page 977).
Other respondents did the safe thing in practice, but their reasoning might not be entirely reassuring to environmental health professionals: "Unpasteurized milk is a definite health threat unless you know your cows," said Janet Robinson, a retiree. And while no one JEH interviewed was currently consuming raw milk, Michael Bailey, a software developer, did take issue with raw-milk laws on philosophical grounds: "Banning it is kind of overboard. There are more important things to be worried about in public health. Alcohol is dangerous, but prohibition was overturned."
Andrea Dupree, program director of a nonprofit organization, said that she would drink raw milk and give it to her children "if it came from a very clean farm"--and that she had in fact done so while traveling in France.
The notion of a "clean farm" may sound naive to environmental health ears. As Pierce reminded JEH, cleanliness is an aesthetic characteristic that has no direct bearing on the question of how healthy a cow might be and what microbes are present. But for the lay respondents, phrases like "cleanliness" and "knowing your cows" had more complex connotations. They functioned as shorthand for a small-scale, labor-intensive, artisanal approach to farming: The farmer knows each cow and the state of its health personally. He keeps his animals healthy, as a recent article in Harper's Magazine put it, "by keeping the creeks that run through his farm healthy, by maintaining the stability of his ecosystem" (Johnson, page 75). In other words, the term "cleanliness" incorporates a systemic critique of mass food production. That critique, which underlies much of the gut appeal of the raw-milk movement, runs something like this: When cows are standing shoulder to shoulder knee-deep in feces, eating feed that makes them susceptible to disease, then of course unpasteurized milk is dangerous. In fact, raw-milk advocates argue that it was pasteurization that made possible the development of factory-farm-style dairy production in the first place. The Harper's article quotes the owner of a dairy in California that sells raw milk:
"E. coli O157:H7 evolved in grain-fed cattle. It's amazing to me that we've sat by as factory farms feed more than half the antibiotics in the country to animals and breed these antibiotic-resistant bacteria at the same time the food corporations are destroying our immune systems." (Johnson, 2008, page 78) Once again, the point here is not that raw milk should be legal. The point is that effective communication on public health is sues requires an awareness of the meta-argument--the level on which the debate is being conducted by consumers and media.
Dismay at the state of American food production is cropping up everywhere in mainstream public discourse. Consider, for instance, an impassioned editorial written in response to reports on factory farming that were recently issued by the Pew Charitable Trusts (Pew Commission on Industrial Farm Animal Production, 2008) and the Union of Concerned Scientists (Gurian-Sherman, 2008):
As both of these reports make clear, the so-called efficiency of industrial animal production is an illusion, made possible by cheap grain, cheap water and prisonlike confinement systems. ... In short, animal husbandry has turned into animal abuse. Manure--traditionally a source of fertilizer--has been turned into toxic waste that fouls the air and adjacent water bodies. Crowding creates health problems resulting in the chronic overuse of antibiotics. ("The Worst Way of Farming," 2008) Perhaps the most high-profile statement of this theme can be found in Michael Pollan's bestselling books, The Omnivore's Dilemma (2006) and In Defense of Food (2008). Pollan suggests that many contemporary public health problems have their roots in "an agricultural system dedicated to quantity rather than quality" (2006, pages...