Can’t keep food safe without the right tools (and using them): Atlanta food truck edition

Part of having a good food safety culture is having all the right tools. But making food safe takes more than having the tools; folks actually have to employ risk reduction practices.

According to AJC.com, an Atlanta food truck failed an inspection after not having handwashing sink and water.hand-washing

Employees at The Corner Hot Foods Service in Atlanta need a sink inside the portable facility where they can wash up while prepping food.

They’ve been going next door into Bims Liquor Store and using a restroom sink instead, said a Fulton County health inspector.

The mobile food service unit is also missing a three-compartment sink to wash, rinse and sanitize dishes. The only sink inside was blocked by a container of food during the recent routine inspection.

Points were also taken off because the food service facility does not have its own water supply, though it is a fixed unit that does not move. The unit should be connected to the city of Atlanta water system, but is instead getting its water through a hose coming from the liquor store, the inspector said.

But do they wash their hands?

Not the headline Batz would have used: Which U.S. foods are most likely to get you sick

Friend of the barfblog.com Michael Batz, says there is a difference between “which foods are most likely to get you sick?” and “which foods cause the greatest burden in the U.S.?”

So he provided commentary on a story he helped create.

The story ran in Fortune, and claimed the U.S. economy will take a $15.5 billion dollar food safety hit through lost income, lost revenue, healthcare-related costs and some intangibles, like “pain and suffering,” according to the U.S. Department of Agriculture.

Research shows the most common foodborne pathogen is norovirus, which is the leading cause of gastroenteritis. The most deadly is listeria; though it is rare, with just 123 confirmed cases in 2013, 24 led to death. The most expensive is salmonella, which is quite common — 7,277 cases in 2013, but with a small fraction (127) resulting in death.

How worried should Americans be about the safety of the food supply? Which foods are most likely to get Americans sick? A deep dive into the data offers a look at where the risks lie.

To identify the most dangerous foods, the Emerging Pathogen Institute, a research institute at the University of Florida, compiled a greatest hits of dangerous pathogen/food pairings. Using a methodology that combined the likelihood of contracting an illness and the illness’s severity to calculate total disease burden, the group identified a Top Ten list of combinations.

Rank Food and Pathogen Cost Illnesses Hospitalizations Deaths
1 Poultry (campylobacter) $1,257m 608,231 6,091 55
2 Pork (toxoplasma) $1,219M 35,537 1,815 134
3 Deli meats (listeria) $1,086M 651 595 104
4 Poultry (salmonella) $712M 221,045 4,159 81
5 Dairy products (listeria) $724M 434 397 70
6 Complex Foods (salmonella) $630M 195,655 3,682 72
6 Complex foods (norovirus) $914M 2,494,222 6,696 68
8 Produce (salmonella) $548M 170,264 3,204 63
8 Beef (toxoplasma) $689M 20,086 1,026 76
10 Eggs (salmonella) $370M 115,003 2,164 42

 The top pairings don’t necessarily map to the major outbreaks of disease; only four of the top ten outbreaks in 2014 were from pairings on the list. J. Glenn Morris, director of the Emerging Pathogen Institute, told Fortune that, outbreaks are “a small fraction” of the total number of foodborne illnesses. In most cases, foodborne illnesses are limited to a small group of people, which makes it difficult for authorities to track.

cdc.fbi.illnessBatz explains the which-foods-cause-the-greatest-burden-in-the-U.S. is about everyone. It is the summary row in a table with 300 million lines, each row representing a different person. Each row could be considered something like individual risk.

(You think you’re a special snowflake? Nope, you’re just a row in the giant spreadsheet of life.)

Our individual risks differ so greatly. Unless you’re pregnant, you don’t need to worry about transmitting Listeria monocytogenes or Toxoplasma gondii to your fetus. Your risks go up when you’re immunocompromised, particularly for some bugs. The young and old face increased risks, though again, every disease is different. People of different ages and genders have different food consumption patterns, too.

And even then, that one row represents risks faced at every meal over the course of a year. Some foods have much higher risks per serving, yet we don’t eat them that often. We consume other foods with lower risks per serving in very high quantities. When you’re telling someone which foods are riskiest, which do you mean? It’s tricky.

Five or so years ago, my colleagues and I published the results of trying to just get at that summary row. Or to be more specific, we tried to say something about which pathogens, which foods, and which pathogen-food pairs cause the greatest public health impact. This kind of information is, I believe, important for getting a handle on the landscape of foodborne disease, to help guide our efforts to reduce the burden.

fbi.batz.pie.chart.nov.15The report had a punchy “top ten” type title and got some attention (for which I’m thankful). But the attention has always come with a price, and that price is that when work like this is written up, it’s almost always presented to readers as some version of which foods to avoid.

I get it, I really do. It’s natural to frame things to readers this way, to take research and make it personally relevant to them. But it kind of butchers the work, and can do as much to misinform as to educate.

So kudos to Tamar Haspal of Fortune for mostly getting it right in an article that presents risks at the broad, national level. Boo to whoever wrote the headline, which conflates population and individual risk and asks “which foods are most likely to make you sick?”

Translating research is always tricky, and I’m never quoted quite to my satisfaction (I can’t get none). In the article, I say we value mortality at $8.7 million per life lost because “there’s also a social welfare value to a life.” Well, that’s not quite right, and I’m doubtful I put it quite that way, and my economist friends are likely groaning at the phrasing, but it’s fine. It’s mostly right, anyway. You have to learn to turn the other cheek.

But other things I just can’t let go. Like the fact that, for the record, I hate pie charts.

More cases linked to Chipotle; some patrons aren’t concerned

As the E. coli O26 cases associated with Chipotle restaurants grows to 45 (with six additional cases linked to restaurants outside the Pacific North West) shares fall and according to Reuters, folks start talking about trust. Blue Bell is dealing with this too, but the cult of Texas ice cream eaters might be stronger than burrito lovers in college towns and the burbs. Or not.

Diners at Chipotle Mexican Grill locations on Saturday said freshness and convenience outweighed concerns about contamination following the news that food poisoning cases had erupted at the chain’s locations in six U.S. states.Screen Shot 2015-11-22 at 10.37.11 PM

“I’m not going to get flipped out by all the horrible things that could happen. I think Chipotle is cutting-edge,” said Marguerite Regan, 50, in Wichita, Kansas.

Brandon Doby, a 19-year-old Colgate University student who picked up food at a Chipotle in Syracuse, New York, said: “I’m aware of the E. coli breakout, but I’ve got bigger things to worry about than E. coli.”

Alex Boucounis, 17, who also ate at the Syracuse restaurant on Saturday, said he was concerned and planned to research exactly which stores had been hit. He said he had not realized that New York was affected.

“It tastes good. It goes down good, and it’s a lot cheaper than bar food, and it’s a lot better for you too,” he said.

“I can’t live my life worried about some minute possibility something might kill me,” said Stan Yao, 29, a Harvard Law School student.

In a statement on Friday, Chipotle said it had expanded testing of key ingredients and examined food-safety procedures in its restaurants in the wake of the outbreak.

“In practice, as someone in food safety and someone who focuses on that and as a concerned customer, I’d want to know what the specifics of that are,” said Ben Chapman, an assistant professor at North Carolina State University who studies food safety.

I was talking about the plans Chipotle lists on their website:

Chipotle is also taking significant steps to be sure all of its food is as safe as possible. Specifically, we are expanding testing of key ingredients, examining all of our food-safety procedures to find any opportunity for improvement, and are working with two renowned food safety scientists to assess all of its food safety programs, from the farms that provide our food to our restaurants.

It’s easy to talk food safety, but what does this all actually mean? Testing of what, for what? What specific food safety procedures. Some details would be nice.

Language and disease control: A partnership made with my partner

We knew it 10 years ago.

ebola.language.nov.15Others knew it centuries ago.

Universities and government are now reinventing the wheel.

Since July 2014, the U.S. Centers for Disease Control  has sent staff on almost 3,000 deployments to support the Ebola response in West Africa, the United States, and elsewhere around the world. Responders fill a variety of roles, from disease detectives, to laboratorians, to logisticians, to health communication experts. Allison Friedman, a CDC health communication specialist, deployed to Guinea in the summer of 2015 to provide communication support for CDC’s Health Promotion team.

“I wanted to play a role in this historic effort and offer any help my skills could offer,” she says. Allison spent three months in CDC’s Emergency Operations Center (EOC) before being deployed to West Africa. Being a French speaker with a background in behavioral science and health communication made Allison a perfect candidate for working at the community-level in Guinea.

While in Guinea, Allison’s job was to work with response teams going into communities to interact face-to-face with them. Social mobilization teams teach communities about preventing and controlling Ebola through door-to-door campaigns, village meetings, and educational sessions. Anthropologists help response organizations by conducting rapid assessments of communities to better understand the cultural, social, and individual factors that influence community attitudes and behaviors related to Ebola prevention and control. Allison helped bridge the gap between the anthropology and social mobilization teams, offering technical assistance with rapid assessments and ensuring that findings were translated into meaningful communication strategies and tools for social mobilizers. Together, the teams spoke with community members about their needs, concerns, perceptions, and proposed solutions for improving the Ebola response. Communities also got a chance to ask and answer questions about Ebola and ways to protect their families, friends, and neighbors.

One of the biggest challenges that Allison noticed in speaking with communities was the conflict between key infection control practices and prevailing traditions and cultural norms. “There are strategies we know to be effective in stopping the spread of Ebola, but convincing people to set aside their deeply held beliefs and practices, like preparing a loved one’s body for burial in the traditional way, is a very difficult thing to do,” says Allison. “It was especially hard in communities without recent Ebola cases, where villagers didn’t see the need to continue with safe and dignified burials.”

An added challenge was gaining the trust of communities that are accustomed to seeking health care from known local healers and do not trust the government or foreign agencies. Communities were more open to accepting prevention and control measures once they received tailored information, reinforced by trusted community and religious leaders and supported by real-life testimonials from Ebola survivors in their areas.

When she returned to the United States, Allison extended her time in the EOC to support efforts in Guinea from the health promotion team in Atlanta, GA. This gave her the opportunity to leverage CDC resources to create needed messages and tools for use in the field. The health promotion team here supports staff in West Africa with Ebola-related communication research, planning, development, and evaluation.

Although there were challenges working in Guinea, Allison says that she found it very rewarding to work with such kind, committed, and patient people on such an important cause.

“I feel deeply enriched by my experiences working with communities and committed partners in the field. I am humbled and awed by the strength of the Guinean people – particularly the Ebola-affected families who have endured losses beyond what most of us can imagine and who continue to face stigma, discrimination and challenges meeting basic needs.”

Finally, she says “I’d also like to give immense credit to my CDC colleagues who have and currently are deployed to West Africa, working tirelessly, with a focus on getting to zero. With their passion, commitment, and perseverance, we are closer than ever to reaching this goal.”

Ebola (Ebola Virus Disease): Health communication in Guinea and Atlanta

CDC

Allison Friedman, Gary Cobb, Arthur Hudson, and Drenda Morrissette, John Saindon and Brian Bird, Karen Wong, Angela Dunn, Brant Goode

http://www.cdc.gov/vhf/ebola/hcp/stories-health-communications-in-guinea-atlanta.html

The secret life of kebabs and donairs

Like Sloan’s Patrick Pentland, I used to be a fan of donairs, kebabs and street meat. Or late-night chinese food. Anything heavy and greasy tastes good after a few beers, but the places serving them have to know the risks associated with what they are serving, and where things might go wrong.

About a decade ago donairs or kebabs were linked to three outbreaks of E.coli O157 in Alberta, and I stopped eating them.mega-donair

Outbreak investigators found that traditional cooking practices including a rotating a cone of meat next to a heat source, were problematic.

Often, especially in the post-bar-closing rush, the heat sources are turned up so the outside of the cone gets scorched, but meat just below the surface doesn’t reach safe temperatures (because it’s being cut off quickly to meet demand). The cooking practice, along with the tendency for the meat cones to be made with ground meat and stored frozen can cause a perfect outbreak scenario.

A national committee was created to look at donair risks associated and the group recommended grilling post cone cut-off to ensure pathogen-killing temps. Good call.

And for those in Australia looking to learn more about kebab culture, according to news.com.au, there’s a reality show for you.

No matter your choice of filling, it’s almost a rite of passage to end up at a kebab shop after a big night out.

A kebab shop worker witnesses everything you would rather forget in the morning.
He sees when you spill the sweet chilli sauce down your white shirt or shamefully profess your love to a stranger.

Mustafa Mohammed has owned Smith Kebabs in Collingwood for more than four years. He has seen it all and has never had a dull moment.

“We get a lot of drunk people in our area, there are a lot of clubs and we have to be patient every day,” he said.

“The challenges are people drink too much and they can’t stand and sometimes can’t even talk.

“They just come in and say ‘I want a kebab’ and you have to try and communicate with them politely to find out what they want.”

Mr Mohammed’s story and the antics in his shop will be revealed on a new miniseries on SBS called Kebab Kings.

Executive producer Michael Cordell said cameras were set up in the kebab shops during peak periods.

“We thought the kebab shops provided an unusual window into contemporary Australia,” he said.

 

A 50-something’s E. coli concerns for his daughter: Johnny Depp edition

I just spoke with my 20-year-old daughter – 4 of 5 and a better goaltender than I’ll ever be — when I read about Lily-Rose Depp, the 16-year-old actress and model daughter of Hollywood star Johnny Depp who publicly declared herself in August to be ‘sexually fluid’, meaning she does not regard herself as 100 per cent heterosexual, it caused a sensation.

courtlynn.hockey‘She’s got thousands of followers on social media, and they were all taken completely by surprise,’ says her father. ‘But not me. I already knew because she tells me everything – she’s not afraid to say anything to me. We’re super-tight and I’m very proud of our relationship. …

‘She’s got a sensible head on her shoulders, and I trust her to lead a sensible, responsible life, but I can’t ever see the day coming when I just switch off to let her make her own way in the world.’

Depp, 52, is possibly a little extra-protective of Lily-Rose because when she was seven, he and Vanessa nearly lost her to an E. coli infection, which she contracted while her father was filming Sweeney Todd in London. Her life was saved by what Depp has described as the ‘terrific’ medical team at Great Ormond Street Hospital. But as he remembers today, there was a period when they were not sure whether the little girl would make it at all.

‘They told us her kidneys had shut down and that she would be lucky to survive. For nine days we sat by her bed, and refused to move until she began to pull through.

‘Filming had to stop. Everything had to stop. It was three weeks before she was allowed to go home. I still think of that time when I’m playing an emotional scene in a movie – it’s something that, when you’ve been through it, you can’t help but tap into.’

But can she play goal?

21 sick: E. coli outbreak linked to Nevada restaurant

Health officials in northern Nevada are investigating more than a dozen confirmed and probable cases of E. coli that might be associated with a Reno restaurant.

twisted.fork.nevadaWashoe County Health District spokesman Phil Ulibarri says 18 of the 21 cases seem to be related to Twisted Fork Restaurant in south Reno. The restaurant’s general manager says it will remain voluntarily closed until an investigation is complete.

Authorities say health officials are working with Twisted Fork to determine the source and investigating food products, storage and preparation methods. The Health District says the restaurant is fully cooperating with the investigation.

Ulibarri says the health district was originally notified of eight E. coli cases on November 4.

Officials say these cases are not related to Chipotle restaurants or cases in el Dorado County.

What is science?

Neil deGrasse Tyson writes, if you cherry-pick scientific truths to serve cultural, economic, religious or political objectives, you undermine the foundations of an informed democracy.

scienceScience distinguishes itself from all other branches of human pursuit by its power to probe and understand the behavior of nature on a level that allows us to predict with accuracy, if not control, the outcomes of events in the natural world. Science especially enhances our health, wealth and security, which is greater today for more people on Earth than at any other time in human history.

The scientific method, which underpins these achievements, can be summarized in one sentence, which is all about objectivity:

Do whatever it takes to avoid fooling yourself into thinking something is true that is not, or that something is not true that is.

This approach to knowing did not take root until early in the 17th century, shortly after the inventions of both the microscope and the telescope. The astronomer Galileo and philosopher Sir Francis Bacon agreed: conduct experiments to test your hypothesis and allocate your confidence in proportion to the strength of your evidence. Since then, we would further learn not to claim knowledge of a newly discovered truth until multiple researchers, and ultimately the majority of researchers, obtain results consistent with one anther.

This code of conduct carries remarkable consequences. There’s no law against publishing wrong or biased results. But the cost to you for doing so is high. If your research is re-checked by colleagues, and nobody can duplicate your findings, the integrity of your future research will be held suspect. If you commit outright fraud, such as knowingly faking data, and subsequent researchers on the subject uncover this, the revelation will end your career.

It’s that simple.

This internal, self-regulating system within science may be unique among professions, and it does not require the public or the press or politicians to make it work. But watching the machinery operate may nonetheless fascinate you. Just observe the flow of research papers that grace the pages of peer reviewed scientific journals. This breeding ground of discovery is also, on occasion, a battlefield where scientific controversy is laid bare.

Science discovers objective truths. These are not established by any seated authority, nor by any single research paper. The press, in an effort to break a story, may mislead the public’s awareness of how science works by headlining a just-published scientific paper as “the truth,” perhaps also touting the academic pedigree of the authors. In fact, when drawn from the moving frontier, the truth has not yet been established, so research can land all over the place until experiments converge in one direction or another — or in no direction, itself usually indicating no phenomenon at all.

Once an objective truth is established by these methods, it is not later found to be false. We will not be revisiting the question of whether Earth is round; whether the sun is hot; whether humans and chimps share more than 98 percent identical DNA; or whether the air we breathe is 78 percent nitrogen.

The era of “modern physics,” born with the quantum revolution of the early 20th century and the relativity revolution of around the same time, did not discard Newton’s laws of motion and gravity. What it did was describe deeper realities of nature, made visible by ever-greater methods and tools of inquiry. Modern physics enclosed classical physics as a special case of these larger truths. So the only times science cannot assure objective truths is on the pre-consensus frontier of research, and the only time it couldn’t was before the 17th century, when our senses — inadequate and biased — were the only tools at our disposal to inform us of what was and was not true in our world.

Objective truths exist outside of your perception of reality, such as the value of pi; E= m c 2; Earth’s rate of rotation; and that carbon dioxide and methane are greenhouse gases. These statements can be verified by anybody, at any time, and at any place. And they are true, whether or not you believe in them.

Meanwhile, personal truths are what you may hold dear, but have no real way of convincing others who disagree, except by heated argument, coercion or by force. These are the foundations of most people’s opinions. Is Jesus your savior? Is Mohammad God’s last prophet on Earth? Should the government support poor people? Is Beyoncé a cultural queen? Kirk or Picard? Differences in opinion define the cultural diversity of a nation, and should be cherished in any free society. You don’t have to like gay marriage. Nobody will ever force you to gay-marry. But to create a law preventing fellow citizens from doing so is to force your personal truths on others. Political attempts to require that others share your personal truths are, in their limit, dictatorships.

Note further that in science, conformity is anathema to success. The persistent accusations that we are all trying to agree with one another is laughable to scientists attempting to advance their careers. The best way to get famous in your own lifetime is to pose an idea that is counter to prevailing research and which ultimately earns a consistency of observations and experiment. This ensures healthy disagreement at all times while working on the bleeding edge of discovery.

In 1863, a year when he clearly had more pressing matters to attend to, Abraham Lincoln — the first Republican president — signed into existence the National Academy of Sciences, based on an Act of Congress. This august body would provide independent, objective advice to the nation on matters relating to science and technology.

Today, other government agencies with scientific missions serve similar purpose, including NASA, which explores space and aeronautics; NIST, which explores standards of scientific measurement, on which all other measurements are based; DOE, which explores energy in all usable forms; and NOAA, which explores Earth’s weather and climate.

These centers of research, as well as other trusted sources of published science, can empower politicians in ways that lead to enlightened and informed governance. But this won’t happen until the people in charge, and the people who vote for them, come to understand how and why science works.

Neil deGrasse Tyson, author of Space Chronicles: Facing the Ultimate Frontier, is an astrophysicist with the American Museum of Natural History. His radio show StarTalk became the first ever science-based talk show on television, now in its second season with National Geographic Channel.

Science and blogs: Gelman vs. Case-Deaton

Case and Deaton, welcome to the blogs.

french knightsProminent academics are often astonished at the rapidity with which the blogosphere occasionally pounces on and dissects their research findings. In this case, it happened to Case and Deaton, authors of a recent much-publicized study entitled “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.” The pounce was done by Phil Cohen, and – most prominently – by Andrew Gelman. 

The TL;DR version is that rising mortality in some of the subgroups spotlighted by Case and Deaton was increased by a composition effect – the average age within the subgroups increased over the observation period, which pushed up death rates for the aggregated subgroups. If you remove the composition effect, the mortality increase among these groups was considerably less.

Anne Case responded with the consternation typical of researchers first encountering blog attacks:

Case said that she didn’t buy this argument. “We spent a year working on this paper, sweating out every number, sweating out over what we were doing, and then to see people blogging about it in real time — that’s not the way science really gets done,” she said. “And so it’s a little hard for us to respond to all of the blog posts that are coming out.”

Academics are used to the cozy, staid world of academia. Responses are slow, polite, and vetted by third parties. Arguments happen in seminars, in office discussions, and at dinners. Disputes are resolved over a matter of years – when they are resolved at all. And never do intellectual adversaries take their case to the general public!

But academics are going to have to get used to blogs. The technological advances of the web have simply made it easier for crowds of outsiders to evaluate research in real time. How often that process produces the “wisdom of crowds”, and how often it merely adds unhelpful noise, remains to be seen. Certainly we’ve seen the internet do both of those things at different times. But blog criticism of research looks like something that’s here to stay, and academics whose work appears in the popular press will have to get used to it!

Blog discourse has some distinct advantages – above all, the speed of responses and the diversity of people who get involved in discussions. How often do you see two economists arguing with a sociologist and a political scientist/statistician? That’s pretty cool! There is, however, a tendency for blog debates to become too antagonistic. 

I think Andrew Gelman’s latest salvo against Case and Deaton falls into this category a bit. He is put out that Case and Deaton have, so far, refused to issue a public mea culpa about what he sees as a major gotcha. Gelman writes up what he thinks such a mea culpa should say, and includes these bits of snark:

Had it not been for bloggers, we’d still be in the awkward situation of people trying to trying to explain an increase in death rates which isn’t actually happening…We count ourselves lucky to live in an era in which mistakes can be corrected rapidly[.]

Gelman is dramatically overstating the importance of what he found! To say that the increase in death rates “isn’t actually happening”, first of all, is not quite right – Gelman’s rough-and-ready composition adjustment removes all of the increase, but more careful examination shows that some portion of the increase remains.

Second, Gelman is kind of assuming that zero is the important benchmark for what constitutes an “increase”. He makes sure to point out that the paper’s main finding – that American white mortality increased a lot relative to various comparison groups – is not changed by the composition adjustment. But when he claims that the increase “didn’t really happen”, Gelman is saying that “increase” is an absolute rather than a relative term.

Andrew, you’re a stats guy. You know full well that people analyzing time-series data detrend stuff all the time. Measuring increases relative to a trend is totally standard practice! 

So like many blog debates, this one ends up making a mountain out of a molehill. The composition effect was a useful and instructive observation, but it doesn’t really change anything about the paper’s result. And publicly demanding that the authors engage in an equally public mea culpa over such a non-issue is a little unrealistic. If it leads to rancor in the long term, that will be a shame.

I like what blogs have done for research, but I think we should work to make those discussions less about point-scoring and more about a cooperative, crowdsourced search for truth.

4 dead, 834 sick from Salmonella in cucumbers from Mexico

Who knew cucumbers could be so vile?

cucumber.spain,MEPThe U.S. Centers for Disease Control, multiple states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Poona infections.

Epidemiologic, laboratory, and traceback investigations identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Two recalls of cucumbers that may be contaminated with Salmonella were announced as a result of this investigation: Andrew & Williamson Fresh Produce and Custom Produce Sales.

838 people infected with the outbreak strains of Salmonella Poona have been reported from 38 states, an increase of 71 cases since the last update on October 14.

165 ill people have been hospitalized, and four deaths have been reported from Arizona (1), California (1), Oklahoma (1), and Texas (1).