Doug Powell

About Doug Powell

A former professor of food safety and the publisher of, Powell is passionate about food, has five daughters, and is an OK goaltender in pickup hockey. Download C.V. »

The Oz effect

More than half of the health advice Dr. Oz gives is either baseless — there’s no evidence for his claims — or wrong — there is evidence, and it contradicts what he says. Julia Belluz tells us not to be surprised:

dr.ozHe is, after all, in the business of entertainment.

But the thing is, there are a lot of Ozzes out there, including in areas you might not consider the entertainment business.

Recently some conference planners tried to recruit me for an event in which I would be presenting the alternative view to the main experts — Arthur Laffer and Stephen Moore. This would be the Art Laffer who among other things warned about soaring inflation and interest rates thanks to the rapid growth in the monetary base (ask the Swiss), and the Stephen Moore who was caught using fake numbers to promote state-level tax cuts.

Obviously these “experts” appeal to the political prejudices of a business audience, but taking their advice would have cost you a lot of money. So why isn’t their popularity dented by the repeated pratfalls? Are they, also, in the entertainment business?

To some extent, the answer is yes. Simon Wren-Lewis had an interesting piece on why the financial sector buys into really bad macroeconomics; he suggested that financial firms aren’t really interested in anything but very short-term forecasting, and that economists working for financial institutions spend rather more time talking to their institution’s clients than to market traders. They earn their money by telling stories that interest and impress their clients. To do that it helps if they have the same worldview as their clients.

Thinking about Dr. Oz also, I’d suggest, helps explain a related puzzle: even if you grant that the right wants alleged experts who toe the ideological line, why can’t it get guys who are at least competent? Why do they recruit and continue to employ people who can’t do basic job calculations, or read their own tables and notice that they’re making ridiculous unemployment projections, and so on?

My answer has been that anyone competent enough to avoid these mistakes would also be unreliable — he or she might at some point actually take a stand on principle, or at least balk at completely abandoning professional ethics. And I still think that’s part of the story.

But I now also suspect that the personality traits you need to be an effective entertainer on inherently not-so-much-fun subjects like health or monetary policy are inherently at odds with the traits you need to be even halfway competent. If Dr. Oz were the kind of guy who pores over medical evidence to be sure he knows what he’s talking about, he probably couldn’t project the persona that wins him such a large audience. Similarly, a hired-gun economist who actually knows how to download charts from FRED probably wouldn’t have the kind of blithe certainty in right-wing dogma his employers want.

So how do those of us who aren’t so glib respond? With ridicule, obviously. It’s not cruelty; it’s strategy.

Push to lift raw milk ban in Australia despite the death of 3-year-old

I used to be self-described lots of things, now I’m not so sure.

the.raw.storeSelf-described food activist Rebecca Freer, who owns an organic store in Thornbury in Victoria (that’s in Australia) claims her rights are being infringed and has begun a petition to legalize it even after the product was linked to the death of a three-year-old child.

“We have a long, long way to go to get the numbers required to be taken seriously … our human rights are at risk if we let the government make the decision on this issue,” she wrote.

The petition on only had 100 supporters on December 12 when news broke of the child’s tragic death, but grew to 250 followers overnight and up to 500 by this week.

Supporters argued raw milk is completely safe and full of “beneficial” bacteria.

Current laws only allow the sale of raw milk as cosmetic or as “bath milk” and labelled “not fit for human consumption”.

Ms Freer said she drank raw milk herself and also gave it to her children.

Please, keep the children out of it, just like you wouldn’t share a scotch and a smoke with your six-year-old.

It’s always the kids who suffer.

Celebrity food porn, NBC style

A food safety type from the U.S. writes that the average viewer of these celebrity chefs are ignorant of safe food handling practices. They are blinded because of the celebrity status of these chefs.

 celebrity.chefsThis past Thanksgiving, I tuned into “Today” and watched celebrity chef Giada prepare ready to eat foods with her bare hands. But worse than that is that she had a bandaid on her finger. At the very least she could have used a finger cot. I emailed the “Food Network three times with no response.

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UK food hygiene inspectors order takeaways and a care home to make ‘major improvements’

Food hygiene inspectors have ordered a number of takeaways, a pub and a care home in the Worksop area to undergo ‘major improvements’, it can be revealed. p_0001The Guardian understands that Thrishna, on Newcastle Avenue; Florentino’s, on Ryton Street; New Mandarin Palace, on Eastgate; Speedy Peppers, on Victoria Square; Boot and Shoe, on High Street, Whitwell and Ashley House, on Sunnyside, all scored a rating of one out of five during 2014. The Food Standards Agency ratings are determined by food safety officers at Bassetlaw Council. The release of the ratings comes ahead of a busy period for food outlets with Christmas and New Year approaching. Coun Julie Leigh, cabinet member for neighbourhoods at Bassetlaw Council, said: “I would urge premises with low ratings to work with the council’s food safety team to put in place robust improvement plans and increase public confidence in their business.” The inspections looked at three elements – how hygienically food is handled, the condition of the structure of the buildings and how the business manages what it does to make sure food is safe. The hygiene standards found are then rated on a scale. At the bottom of the scale is ‘zero’ – which means urgent improvement is required. At the top of the scale is ‘five’ – which means standards are very good.

Taiwan recalls tainted dried tofu in fresh food scare

In Taiwan’s latest food scandal, almost 40 types of flavored dried tofu (bean curd) involving ten different companies are suspected to have become contaminated with dimethyl yellow, which is linked to cancer in animals.

UnknownTaiwanese authorities ordered more than two tonnes of tofu (bean curd) be removed from shelves on Wednesday (Dec 17) over fears it could contain a banned industrial dye, in the island’s latest food scandal. 

Almost 40 types of flavoured dried tofu involving ten different companies are suspected to have become contaminated with dimethyl yellow, which is linked to cancer in animals, the Food and Drug Administration said. The administration ordered any manufacturer that used ingredients supplied by the Chien Hsin company that they suspect of being contaminated to recall their products by Saturday or risk a maximum fine of NT$200 million (US$6.3 million).

Chien Hsin is accused of selling soybean emulsifiers that were adulterated with the industrial dye, which is banned from food products, to at least 44 manufacturers.

Televised medical talk shows—they’re just BS

I’ve written before about how I was unceremoniously relegated to the cheap seats because I wouldn’t go along with the story line on Dr. Oz a couple of years ago; it wasn’t factual and they weren’t interested in facts.

powell.costa.dr.oz.09Now, researchers report in the British Medical Journal that TV talk shows like Dr. Oz and The Doctors are full of it at least 50 per cent of the time.

Objective To determine the quality of health recommendations and claims made on popular medical talk shows.

Design Prospective observational study.

Setting Mainstream television media.

Sources Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors).

Interventions Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show.

Main outcomes measures Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made.

Results We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.

Conclusions Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.

UK ice cream parlor fined after boy’s mouth injuries

An ice cream parlour has been landed with a £12,000 fine after a boy sliced his tongue on a shard of glass hidden inside a chocolate sundae.

2381345411The 11-year-old was tucking into the dessert at Scoops Gelato, in Elm Grove, Southsea, during a trip with his mum when he was left in agony and bleeding from the mouth.

The boy needed stitches at Queen Alexandra Hospital, in Cosham, Portsmouth, as a result of the ordeal.

Portsmouth City Council’s trading standards team, prosecuting Scoops Gelato at Portsmouth Magistrates’ Court yesterday, revealed an error made by staff resulted in the accident.

A worker preparing the dessert tapped the glass with a scoop to pour in the ice cream, unwittingly causing part of it to break and fall in.

Victoria Putnam, council prosecutor, said the cut in the boy’s mouth was ‘severe’ and ‘deep’ – and blamed the firm’s failure to adopt the basic safety procedures of a normal food business for the accident, which happened on June 21 this year.

‘Had the businesses put steps in place – which it has put in place since that incident – it would never have happened,’ she said. 

Survey of mycotoxins in dates and dried fruits from Tunisian and Spanish markets

In an effort to enforce the knowledge on mycotoxin occurrence and co-occurrence in dates and dried fruits, 228 samples purchased from Tunisian and Spanish markets were subjected to multi-mycotoxin liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis of 16 mycotoxins.

OLYMPUS DIGITAL CAMERAAt least one mycotoxin was detected in 160 samples (70%). The frequency of contaminated samples was 83%, 80%, 64%, 59% and 26% for dates, dried vine fruits, figs, apricots and plums, respectively but none of the analyzed samples contained detectable levels of fumonisins (FB1, FB2, FB3) or T-2 toxin (T2).

The incidence and levels of mycotoxins varied in samples. The most prevalent mycotoxin was enniatin B (EnnB) (54%), followed by enniatinA1 (EnnA1) (36%); aflatoxins (AFs) (23%) and ochratoxin A (OTA) (22%). Thirteen samples contained AFs in levels that exceed the maximum limits established in EU legislation. The simultaneous contamination with 2–6 mycotoxins was observed in 51% of the analyzed samples. Lastly, intakes of the detected mycotoxins were calculated for average adult consumers and compared with the tolerable daily intakes (TDI). Data obtained were used to estimate the potential exposure levels.


Seattle reinvents the wheel: A, B, C or E. coli? King County to get restaurant rating system

Seattle, self-proclaimed home of all things food safety, is finally going to get a restaurant inspection disclosure program, about 15 years after Toronto (there’s older programs, but that the one I was involved with).

 rest.inspec.grade.louisvilleKing County announced this week that it will begin posting food and health safety ratings for all to see. The new rating system will affect approximately 12,000 restaurants and food trucks in the area, starting in late 2015, according to the Seattle Times.

Schacht’s campaign for more transparency was also spurred by how difficult it was to find an establishment’s rating through King County’s existing health department site. Her petition called it a “convoluted inspection ratings system that confuses consumers.” More than 2,000 people agreed and signed her petition for clearer signs to be posted at restaurant locations.

Rating restaurants is already status quo in other major cities, like New York and Los Angeles. Now Seattle will join the ranks of this handy system, which lets customers get a good look at how clean a joint is before they enter.

The use of restaurant inspection disclosure systems as a means of communicating food safety information


The World Health Organization (WHO) estimates that up to 30 per cent of individuals in developed countries become ill from food or water each year (World Health Organization 2007). Up to 70 per cent of these illnesses are estimated to be linked to food prepared at foodservice establishments (Lee & Middleton 2003; Olsen et al. 2000; Todd 1998; Center for Science in the Public Interest 2008). Media coverage of food safety issues is extensive and may fuel the view that hygiene standards are low among restaurants (Bruhn 1997; Worsfold & Worsfold 2008). Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year-to-year (Food Marketing Institute 2008), with many consumers attributing foodborne illness to foodservice (Fein et al. 1995). One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant (Worsfold & Worsfold 2007). Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions (Worsfold & Worsfold 2007).

Restaurant food safety standards are assessed through routine examinations. These examinations, also called health, hygiene, foodservice or restaurant inspections, are principally designed to prevent restaurant-associated foodborne disease outbreaks (Jones et al. 2004; Reske et al. 2007). In addition, restaurant inspections may significantly impact consumer confidence in the safety of restaurant food, influence dining decisions, and provide incentives for establishments to promote a safe food environment (Fielding et al. 2001; Jin & Leslie 2003; Simon et al. 2005; Worsfold & Worsfold 2007) when publically available.

About the inspection process

The fundamentals of restaurant inspection are well established throughout developed countries. Municipal restaurant inspections are food safety risk management programs, an action, to demonstrate to consumers that food providers are cognizant of consumer concerns about food safety, and demonstrate that those within the farm-to-fork system are working to reduce levels of risk (Powell 2002).Methods of scoring inspection results vary between jurisdictions. The criteria for inspection is fairly well established, however inconsistencies between municipalities exist when defining a critical violation. Though often described as a violation more likely than others to contribute to food contamination, illness, or health hazards, the actual items that constitute a critical violation during the inspection process may vary. In some jurisdictions the presence of a critical violation elicits closure followed by re-inspection, and in others it simply results in a lower inspection score. As a result, many systems exist to quantify results during inspection. Starting with a value of 100 and subtracting violations (with critical violations being a larger deduction) is one method. In this method, a score of 100 is awarded to establishments that comply with food hygiene standards. Conversely, beginning with zero and tallying violations (with critical violations being worth a higher value), a larger numerical value indicates a riskier food establishment. Other jurisdictions simply tally violations, and may or may not indicate whether these are critical or non-critical. Variations not only exist between jurisdictions or municipalities, but between inspectors; though inspector training is designed to synchronize violation interpretations, it will vary from person to person. The many variables of the inspection process will affect inspection disclosure schemes, but are outside the scope of this paper.

OC.color.gradesInspection disclosure

Systems to communicate the information acquired through restaurant inspection to the public are common in developed countries; however, these systems are inconsistent, varying between countries, states or cities. In some jurisdictions, a consumer must formally request to view the most recent inspection, and may wait months before receiving the results (Center for Science in the Public Interest 2008). In other jurisdictions, it is available upon request at the restaurant. These methods are neither convenient nor reasonable for most consumers, as inspection reports are often difficult to understand (Center for Science in the Public Interest 2008). Disclosure systems in which inspection information must be requested by the consumer provide minimal incentive for foodservice establishments to produce safe food. Seiver & Hatfield (2000) suggest that the public disclosure of restaurant inspection results communicates the importance of risks and violations found during an inspection. With several of the key elements of a foodservice operation being hidden from consumers (such as food storage conditions, or where food is purchased) consumers will look to observable information cues during establishment selection (Henson et al. 2006). Restaurant inspection disclosure systems can provide such information cues.

Grading systems enforced by public health agencies have spread worldwide since being established in 1924, at which time letter grades were introduced to classify milk in the United States (Boehnke 2000). Disclosure systems are growing in popularity, largely due to consumer demand for such tools.After seven years of discussion, the U.K. Food Standards Agency began a pilot program, “Scores on Doors”, with local authorities to establish a U.K.-wide system to provide restaurant inspection results to the public. The U.K. pilot programs used a variety of codes, including star ratings, smiley faces, letter grades and the phrases “pass” or “improvements required” (Worsfold & Worsfold 2007). The first of the U.K. “Scores on Doors” program was introduced in 2004, and only 3 years later over 30 different schemes were operating throughout U.K. municipalities (Worsfold & Worsfold 2007). Similar inspection disclosure systems involving these codes, and others, are in place in several cities, states and provinces around the world. The codes attempt to simplify inspection results into a format that is understandable and intriguing to consumers dining at an establishment.

Inspection disclosure systems can be organized into three categories: those that provide information through municipal or state health departments, those that provide information online, and those that provide information at the establishment. Inspection reports disclosed through health departments often must be accessed through a Freedom of Information Act (Worsfold 2006a). Online databases vary in content, and may be used to compliment disclosure at the premise. Maintenance of online restaurant inspection databases may be by local health departments, news stations, or increasingly, consumer blogs. Disclosure systems displaying information at the establishment do so in the format of a card, with most inspection authorities requiring the cards to be posted in designated, conspicuous locations visible to patrons entering the restaurant (North Carolina Administrative Code 2005).

The following are examples of restaurant inspection disclosure systems:

Online database of results. Many disclosure systems at the establishment are complimented by an online database of inspection results, with the format and content of these websites varying between municipalities. Since the first posting of inspection results online in Los Angeles (L.A.) County in 1998 (Fielding et al. 2001), many inspection authorities have adopted this medium to present a database of results searchable by establishment name or code, neighborhood, location, or results from the latest inspection (New York City 2008; DPR Online Services 2008; Office of Environmental Health Services 2008). Some of these databases provide only the number of critical violations, or of both critical and non-critical violations, while others elaborate with details of the cited infractions. Some jurisdictions, such as the U.S. state of Alaska, provide online copies of all food establishment inspection reports completed by inspectors (Division of Environmental Health 2008). Other inspection authorities allow consumers to receive e-mail updates when new inspection results are posted (Central District Health Department 2007).

Presently in the U.K., food establishments may voluntarily post inspection scores or symbols at their premises, but are not required. However, all inspection reports are available through local inspection authority websites (Worsfold & Worsfold 2008). Websites appear to be a popular method of restaurant disclosure, with many municipalities adopting this medium. Several areas in Scotland began posting inspection results in November 2006 after a survey found 82 per cent of consumers wanted to see inspection information at local eating establishments, and 94 per cent thought it should be accessible online (Worsfold & Worsfold 2007). Consumers and businesses reported that the posted results were valuable, according to research by the Food Standards Agency of Scotland several months later (Worsfold & Worsfold 2007). However, a review of the DineSafe disclosure scheme in Toronto, Canada revealed only 10 per cent of the public was aware of the online component, compared to 75 per cent being aware of inspection notices posted at the premise (Toronto Staff Report 2002). Additionally, though initially popular, online disclosure websites may receive decreased visits after the initial novelty of the system wears off, as the city of Waterloo, Canada experienced (Barrick 2009).

Online name-and-shame. Rather than a database of results, online name-and-shame notices are published by the Food Safety Authority of Ireland, where foodservice establishments that fail to improve conditions of practices deemed “likely to pose a risk to public health” are issued an Improvement Order that is posted on the Authority’s website until the situations are corrected. Following correction, the Improvement Order remains visible to the public for another three months. A Closure Order is issued if “there is likely to be a grave and immediate danger to public health” or an Improvement Order is not complied in a timely fashion. These orders are likewise posted to the website until situations are remedied, and for three months afterwards (Food Safety Authority of Ireland 2008). grades. The California county of San Diego was one of the first regions in the U.S. to create a disclosure system to convey inspection results to the public, introducing letter grades to rate establishments in 1947 (Foley 2009) L.A. County followed suit, and since 1996, has required food establishments to display the results of their most recent restaurant inspection in the form of an A, B, or C letter grade; except in the case of restaurants scoring below a ‘C’, for which the actual numerical value is provided (Teledas Co. 2004). Multiple major U.S. cities have adopted similar systems, as have several states. In Auckland, New Zealand, a food hygiene grade from A to E is assigned to inspected establishments, with the exception of ‘C’, as it may be mistakenly thought of as a ‘passing’ grade, and the addition of a Gold A, which recognizes establishments that demonstrate safe practices above full compliance with food hygiene laws. The hygiene grade must be displayed “in a prominent position on the premises that is visible to the public” (Auckland City Council 2007). Other examples of letter grade systems include: AA, A or B grades; A or B grades; and A, B, C or D grades (Pytka & Fellow 2005).

Numerical scores. A common checklist for restaurant inspection used in the U.S. is the FDA-approved Foodservice Establishment Inspection Report. This is a 44-point list of violations assigned a weight based on their risk to human health. The highest possible score is 100, which is reduced when violations are cited. Though the inspection checklist may be consistent, what constitutes establishment closure is not. In Danbury, Connecticut, an establishment must score 80 and not receive any 4-point violations to receive a pass; in Nashville, Tennessee, a score of 70 is required to pass inspection. In Mobile, Alabama, a score below 85 elicits closure and re-inspection (Mobile County Health Department 2008). The numerical score and copy of the inspection report are required to be posted at the establishment. Inspection authorities that do not deduct violations from 100, but rather a more unattractive number, will often later convert this value to one out of 100 for the sake of simplicity. Converse to deducing points for violations, in New York City, health officials assign a numerical score during inspections that tallies violations. Scores greater than 28 denote the restaurant as a public health hazard, and must be re-inspected to ensure corrections are made (New York City 2008). New York City has recently proposed a plan to disclose inspection results to the public using a letter grade system similar to that of L.A., rather than posting a numerical score card at the premises (Collins 2009).

            Colored cards. Officialsin the city of Toronto, Canada, require food establishments to display their most recent inspection results in the main entrance of premises in the form of a green, yellow or red card, indicating a pass, conditional pass, or closed notice, respectively (City of Toronto 2008). During the development of the Toronto disclosure system, a review of current literature indicated that color could be used to draw attention and suggest caution (Powell 2002). A similar system used in Columbus, Ohio, includes the green, yellow and red color cards, with the addition of a white notice that is issued when an establishment is on probation and requires a follow-up inspection. The red card in this case is used when an establishment on probation failed re-inspection (Columbus Public Health 2006). Using a combination of numerical and color disclosure schemes, Lexington-Fayette county in Kentucky discloses scores of 85 or above, and no four- or five-point violations, receive the score posted in green; 84 and under, or those with four- or five- point violations will be posted in red; and those below 70 will be issued “Notice of intent to Suspend Permit” (Lexington-Fayette County 2008).

            Statement cards. The Niagara Region of Ontario, Canada conducts inspections similar to those in the city of Toronto, however its disclosure system describes inspected establishments as simply “in compliance” or “not in compliance.” This region also maintains an online database to convey the most recent inspection results to consumers, with details of critical and non-critical violations (Regional Municipality of Niagara 2008). A study in Hamilton, Ontario (Hensen et al. 2006)—a municipality which initially used only “pass” and “fail” notices, but was considering utilizing the “conditional pass” notice—found that the additional “conditional pass” option had a “significant and negative impact” on survey respondent’s self-reported likelihood to patronize a restaurant. Other examples of information statements include: “approved” or “not approved”; “satisfactory” “conditionally satisfactory” or “unsatisfactory”; “exceeds minimum standards” “meets minimum standards” or “does not meet minimum standards” (Pytka & Fellows 2005).

            Symbols. Since 2001, the Danish Veterinary and Food Administration has used smiley faces as a means to disclose restaurant inspection results to the public. The full details of Danish inspection reports are published on a website (, with a “smiley” face depicting five different scenarios, which range from a sad, “sour smiley”—assigned to establishments that were issued a fine, reported to the police, or had approval withdrawn—to an ecstatic “happy smiley” for restaurants that received no negative remarks. The newly added Elite-Smiley may also be awarded when establishments receive the happy smiley in four consecutive inspections. These reports and respective smiles must be posted at the restaurant premises, and visible to consumers outside the establishment who are making a choice to dine there (Danish Veterinary and Food Administration 2008). Inspection results in the northern region of the U.S. state of Iowa are conveyed using the 5-Star Program in which colored stars assigned to establishments correspond with positive food handling behaviors observed during inspection. A yellow star is awarded when proper holding temperatures are respected; a blue for proper cooking; red for clean equipment; brown for good employee hygiene; and a green star when the establishment’s food ingredients are received from safe sources. For each inspection the restaurant’s awarded stars are displayed online alongside the number of critical and total violations cited (Cerro Gordo County 2008). In the U.S. state of Connecticut, Farmington Valley and Norwalk counties, respectively, use waiter or lighthouse symbols to disclose inspection information: a score of 90-100 receives 3 waiters or lighthouses, 80-89 receives 2, and below 80 receives 1 (Farmington Valley Health Department 2009; Norwalk Health Department 2009).

            Award schemes. In addition to inspection disclosure systems, several municipalities have elected to provide awards for establishments that exceed food safety standards. The aforementioned Gold A granted in Auckland, New Zealand, or the Elite Smiley in Denmark, are examples of these award schemes, and often are in addition to existing disclosure systems at the establishment. During evaluation of the Eat Safe award scheme in the U.K., Worsfold (2005) found 79 per cent of those surveyed said they would be influenced by the presence of a hygiene award. However, it is noted in previous evaluations that there is little public awareness of a similar award scheme in Scotland (Worsfold 2005).

There is no agreed upon best method to communicate inspection results with the public, with many vehicles being used throughout the world (Powell 2002). Although many restaurant inspection disclosure systems exist, further research could determine which of these existing schemes are most effective.

Benefits of disclosure systems

Consumers both desire and deserve accessible and understandable information on the conditions and practices of foodservice establishments. Consumer interest in the website that discloses inspection results for the U.K. city of Liverpool generated 100,000 hits within two days of posting the first inspection results (Chartered Institute of Environmental Health 2007). Information provided on such mediums can be a comfort to diners, demonstrating that restaurants are being monitored for food hygiene standards. According to the director of public health for L.A. County, Dr. Jonathan Fielding, the grading system used in L.A. bolsters consumer confidence in the county’s restaurant inspection system (Center for Science in the Public Interest 2008). Consumers in the city of Hamilton, Canada were asked how important the presence of an inspection notice in a restaurant’s window was when choosing where to dine, and respondents assigned it an average importance of 4.44 on a 5-point scale (Henson et al. 2006). As many as 95 per cent of residents surveyed in Toronto, Canada, indicated they made dining decisions based on the colored inspection cards posted at establishments (Toronto Staff Report 2002).

By influencing restaurant choice, inspection result postings can provide incentives for those within the foodservice industry to focus on food safety endeavors. Restaurateurs and patrons react emotionally to posted scores (Wiant 1999). Public reporting of poor inspection results may lead to negative consumer attitudes towards an establishment, and consequently influence foodservice workers and managers to comply with regulations in order to improve food safety scores (Almanza et al. 2002). According to the Ministry of Food Agriculture and Fisheries in Denmark, over half (59 per cent) of consumers have changed their dinner plans after reviewing the smiley face posted at a restaurant. The Ministry asserts that the smiley scheme is one of the best-known consumer public schemes in Denmark, and a recent survey found that 97 per cent of consumers felt the scheme was a “good” or “very good” idea, as did 88 per cent of foodservice businesses. Additionally, 8-out-of-10 managers or owners reportedly discussed practices with their staff that would lead them to attain the coveted “happy smiley” (Danish Veterinary and Food Administration 2008).

Hospitalization rates linked to suspect foodborne illnesses were seen to decrease by approximately 20 per cent in the year a mandatory letter grade disclosure system was implemented in L.A. County (Simon et al. 2005; Jin & Leslie 2003). However, limitations in surveillance data make it impossible to determine in which settings the majority of foodborne illnesses occur (Powell 2002), let alone the relationship between inspection disclosure systems and a reduction in illness rates. Restaurant grade cards in L.A. did promote food safety awareness in the public, and provided incentive for restaurants in the county to comply with food safety regulations and increase inspection scores (Fielding et al. 2001; Jin & Leslie 2003). A similar system in Las Vegas, Nevada also found that establishments were more likely to increase diligence in food safety practices to maintain compliance (Hahn 2000). A review of the color-coded disclosure system in Toronto, Canada, concluded it successfully “increased compliance and continuous improvement in food safety” among Toronto restaurants (Basrur 2003). Food safety violations were also reported to decrease for the city’s restaurants (Toronto Staff Report 2002).

Tools that compliment inspection disclosure schemes, such as hygiene information on a respected website, can and will be used by a proportion of consumers, though it should not be used to substitute disclosure at the premises (Spear 2006). The Toronto, Canada study indicated that consumers were more aware of disclosure at the premise, in the form of colored cards, than the website (Toronto Staff Report 2002). According to Worsfold & Worsfold (2008), online disclosure systems provide the computer-literate consumer quick and relatively easy access to inspection information.


Issues with inspection disclosure

The process of restaurant inspection itself is fraught with issues (Chapman et al. 2008):

  • frequency of inspection varies between jurisdictions;
  • inspections may be scheduled or unannounced depending on the jurisdiction;       and,
  • time of day an inspection occurs may affect an establishment’s performance, as busier times result in increased food hygiene infractions .

Criteria for inspection is inconsistent — most notably the definition of ‘critical violation’ varies between jurisdictions. During the inspection process there are several food safety issues that are difficult to assess in the brief timeframe of an inspection, such as acquiring food from a safe source. Perhaps one of the most significant issues with the inspection process is the variation between inspectors due to subjective interpretation: what one inspector may view as a violation may not be a violation to another inspector (DeNucci 2007). Though standardized training is often required for health inspectors, subjective interpretation is a continuous issue.
The purpose of restaurant inspection is ultimately to reduce the incidence of foodborne illness, yet research has indicated that inspection scores are not predictive of foodborne illness outbreaks. In a review of 167,574 inspections in the U.S. state of Tennessee between January 1993 and April 2000, Jones et al. (2004) found that mean inspection scores of establishments experiencing foodborne illness outbreaks did not differ from establishments without reported illnesses. Cruz et al. (2001) reviewed inspection scores for 51 food establishments associated with confirmed foodborne illness outbreaks in Miami-Dade County, Florida, in 1995 and compared these reports to randomly selected establishments without outbreaks. The study suggested that inspections in Miami-Date County did not reliably identify restaurants with increased risk of foodborne illness (Cruz et al. 2001). Though other studies have focused on the relationship between restaurant inspection scores and foodborne illness, methodological problems decrease the veracity of these studies.

While inspection scores are not predictive of foodborne illness outbreaks, creating a study that accurately measures the relationship between restaurant inspection scores and foodborne illness outbreaks is difficult. As Jones et al. (2004) suggest that “reported foodborne outbreaks are rare in relation to the number of restaurants and the small percentage of suspected foodborne illnesses linked to epidemiologically confirmed, restaurant-associated outbreaks make such analyses difficult.” With numerous variables and inconsistencies in the restaurant inspection process itself, health inspectors and those within the foodservice industry debate whether consumers are able to understand the meaning of posted inspection information (Almanza et al. 2002). Multiple studies suggest consumers may have little understanding of the meaning of posted letter grades or inspection scores, though their interpretations play a role in their choice to patronize a restaurant (Dundes & Rajapaksa 2001; Hensen et al. 2006).

Accurately quantifying all of the aspects of inspection to create a risk communication tool that can convey a message about the safety of a food establishment is a daunting task. Jones & Grimm (2008) found that, in a region where restaurants were required to make inspection results publicly visible on their premises and allow information to be disclosed on the Internet, survey participants indicated the availability of this information had an effect on where they chose to eat. However, the researchers also found that consumers have a number of misconceptions and unrealistic expectations of the restaurant inspection system (Jones & Grimm 2008). Worsfold (2006b) suggested that restaurant patrons are not well informed about the role of local authorities in protecting food safety and how the food safety laws are enforced. For example, consumers may be confused as to how often inspections take place and, therefore, how frequently violations occur at an establishment (Hensen et al. 2006). Restaurant inspections report on the conditions of an establishment at a single point in time, and may not reflect the overall (good or bad) culture of food safety at the restaurant (Chapman 2008). Though an inspection is only designed to evaluate an establishment at one moment in time, patrons interpret scores as an overall indicator of quality (Wiant 1999).

Details of inspection reports may also be difficult to understand. Consumers may have difficulty assessing the severity of violations cited in terms of their risk to food safety (Worsfold 2006b). Additionally, inspection and disclosure systems can vary between jurisdictions, which may lead to confusion among consumers who dine in multiple jurisdictions. An examination by the San Diego Union-Tribune of inspection data in San Diego County, California, found that restaurants receiving an A grade—the top rating for that jurisdiction—may have also been cited for up to two major violations, which are those thought to “pose an imminent health hazard.” The newspaper noted that most jurisdictions throughout the U.S. are reluctant to award establishments a top grade with even one major violation in their report (Williams & Armendariz 2007). These variations in what constitutes a score between jurisdictions can be confusing for consumers, but even with a unified system problems will arise. Hatfield & Siever (2001) found with numerical grading schemes, consumers still think in terms of pass/fail. This may be true in the case of letter grades, colored cards, or any other disclosure methods.

Pressure from the restaurant industry may hinder implementation (Wiant 1999). Worsfold (2006a) found some objection among hospitality and food service management to the ‘Scores on Doors’ program in the U.K. Some managers were averse to implementing public disclosure systems for fear of confusing consumers, as mentioned above, or the difficulty and cost of implementing such a program (Worsfold 2006a). Additionally, concerns have been raised in simplifying the complexities of the restaurant inspection report into a single score, grade, or symbol (Worsfold 2006a).


Research needs

Previous research has focused on assessing the effectiveness of implemented inspection disclosure systems, but has not determined which system or medium is most desired by consumers. Research should focus on determining which medium consumers and those within the food industry prefer inspection information to be disclosed through, and whether complimentary tools are something consumers and restaurant operators want.

Do consumers prefer disclosure at the premise in the form of cards, and if so, which format — letter grades, numerical scores, symbols, colored cards, or phrases — is preferable? Various scores and grades have been used to communicate restaurant inspection results to the public, but which of these is most effective is not known. Even within a particular score category, such as letter grades, there are unknowns. For example, how effective is a 3-tier scheme of A, B, and C compared to a similar 4-tier letter scheme? Are consumers misled with those middle terms, like ‘C’, as some jurisdictions predict? Are multi-tier schemes the best way to communicate inspection results to the public, or do consumers solely think in terms of pass/fail as some research has shown (Hatfield & Siever 2001)?

Additionally, it is unknown to what degree inspection information should be disclosed to consumers. Examples of score schemes vary from a simple notification of “pass”, “conditional pass”, or “fail” (City of Toronto 2008), to detailed pictograms color coordinated to expose various elements of the inspection process (Cerro Gordo County 2008).

It is unknown whether a combination of mediums is most effective – e.g. score cards displayed on premises with basic information, and further details of infractions available online – or, whether one medium alone is most desired by consumers. Research should focus on determining the most compelling method for communicating results to the public. Once this method is determined, creating a consistent system within states or countries can be assessed.

Food safety is not the only factor affecting consumer patronage to dining establishments. Many studies have researched these factors, indicating that friends/relatives/colleagues, media (newspapers and TV programs), image, atmosphere, food quality and cost, and overall cleanliness are factors affecting one’s decision to dine in a particular establishment (Worsfold 2006a; Gregory & Kim 2004; Leach 2003; Cheang 2002). Although some research has indicated consumers rate food safety as more important than any other factor (Worsfold, 2006b), and it is self-reported that consumers would not dine at an establishment with a poor inspection rating (Worsfold 2006b; Leach 2003), whether this would, in reality, affect a diner’s decision is unknown. The ‘loyalty’ factor—consumers who dine at an establishment in support of a cause/friend/relative/colleague—also may affect one’s decision to dine at an establishment, regardless of the above-mentioned qualities. Research could determine whether pairing restaurant food safety scores with that of quality, cuisine and atmosphere is attractive to consumers. Finally, what approach is best to acquire information about consumer preference of disclosure systems?



Restaurant inspections are flawed and may appear complicated, but foodservice safety information is something consumers desire. Public disclosure of inspection information helps foster a culture of food safety by encouraging dialogue about food safety issues among both consumers and those within the foodservice industry. Research cannot assume that because inspection is complicated it is beyond the scope of a public disclosure scheme. Research should focus on providing compelling information through the most consumer-desired medium or combination of mediums, while encouraging those within the foodservice industry to promote a safe food-handling environment. Once these tasks have been accomplished, disclosure system consistency within a state or country should be developed. Perhaps ultimately public inspection disclosure systems will be embraced by those within the foodservice industry and be a way for restaurants to market food safety.



The authors would like to acknowledge the assistance of Casey J. Jacob in the preparation of this manuscript.


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UK Aldershot takeaway ‘improving’ after zero hygiene rating dished out

A takeaway in Aldershot has been given a slap on the wrists for a series of food safety failings.

Hafeez in Station RoadHafeez in Station Road was issued two cautions by Rushmoor Borough Council on Thursday following an inspection.

The action came in relation to six food safety offences and a further health and safety offence

As a result, the takeaway has been given a food hygiene rating of zero – the lowest on the Food Standards Agency’s national rating scheme.

However, Hafeez has taken steps to improve the situation and will be working with the council in the coming months to ensure it meets appropriate standards.

Councillor Ken Muschamp, RBC cabinet member for safety and regulation, said: “I am fully supportive of the stance taken by the council’s food team to protect the health of residents.

“I would urge residents to use the scheme to check the hygiene status of food businesses in the borough.

“I only eat in food businesses that have a four or five rating. If a food business doesn’t display their hygiene rating sticker, I would ask why.”