Perceptions About Raw Milk Consumption

1
Perceptions About Raw Milk Consumption
2
Milk Consumption

• Although milk is not universal, it is one of the
  most widely consumed foods that humans get from
  other animals  get map from harris chapter
• Evolutionarily, milk is a complete and well
  balanced food for infants of the species that
  biological verity has been extended to a view
  that milk is the ideal food for humans,
  particularly to sustain growth in children, fetal
  growth in pregnant women, and milk production
  during lactation and that natures most perfect
  food 

3
Milk Consumption

• Historically, milk was drunk raw or preserved
• Raw milk sours because of natural lactobacilli
• Cultures that drank milk dealt with spoilage and
  long term storage in several ways
• Consumed immediately or boiled for later use
• Yoghurt, cheese, buttermilk, sour cream
• Possibility of acquired immunity to zoonotic
  pathogens through care of farm animals
• Pasteurization has two functions
• Kills spoilage organisms that sour milk
• Kills pathogens that can cause serious illness

4
Traditional View of Milk Practiced in Bangladesh
Today

• Dairying is practiced in Bangladesh as a part of
  local crop livestock farming systems, typically
  involving involving one or two animals and half
  an acre of land
• The cows are mostly maintained as bull mothers
  and to produce a little surplus of milk (0.51.5
  liters daily) for household consumption
• Some fermented milk products, such as yogurt,
  cheese, buttermilk, and sour cream, are produced
  by traditional methods

5
Origin of Microbial Contaminants

• At the point of milking, microorganisms in milk
  come from animal body surfaces, feed, air, water,
  and utensils and equipment used for milking and
  storage 
• The main causes of increased bacterial count
  during transportation of milk  are contamination
  due to inadequately cleaned vehicles
• There are also occasionally pathogens in the
  teats, e.g., Mycobacterium bovis (tuberculosis),
  M. johnei (paratuberculosis), S. aureus
  (mastitis)

6
Contamination of Raw Milk

• The main causes of increased bacterial count
  during transportation of milk  are contamination
  due to inadequately cleaned vehicles
• Inclusion of milk from a single farm with high
  bacterial counts can have a significant event on
  the total colony count of tanker milk as well

7
Some Raw Milk-related Outbreaks from 2000-2002
Year           Location Source Casual agent  Number ill
2002 Edmonton Raw milk Campylobacter 5
2001 Wisconsin Raw milk Campylobacter 75
2001 British Columbia   Goats milk                   E.coli O157H7            3
2000           Austria Raw milk Campylobacter 38
8
Pasteurization

• Pasteurization involves the heating of milk to a
  temperature of 71.7oC for a period of 15 seconds
  (or for a similar combination of temperature and
  time)
• Most milk sold in developed countries is
  pasteurized
• Farming families are typically exempt
• A relatively small number of people defend their
  right to drink raw (unpasteurized) milk
• Therefore, most European countries and more than
  half of the U.S. states allow the sale of raw
  milk even if the volume is very low

9
Pasteurization

• Part of broader movement for public health and
  liberal welfare state
• Pasteurization is incorporated into food
  regulations in UK, other European countries,
  Canada, U.S.  

10
Current Federal Regulations and Policy in the
United States

• United States restricted the sale of raw milk
  products since the 1940s
• U.S. Department of Health and Human Services
  banned the interstate shipment of raw milk in
  1986

11
Current Federal Regulations and Policy in the
United States - FDA and CDC

• The health risks associated with the consumption
  of raw milk far outweigh any benefits derived
  from its consumption.
• There are numerous documented outbreaks of
  milkborne disease involving Salmonella and
  Campylobacter , E. coli O157H7, Listeria
  monocytogenes , Salmonella and Yersinia
  enterocolitica infections directly linked to the
  consumption of unpasteurized milk in the past 20
  years

12
Current Regulations in France

• In France, the sale of raw milk destined for
  human consumption is authorized but strictly
  controlled by a ruling of the Ministry of
  Agriculture of 1985, which provides for different
  levels of restrictions.
• unblemished record of no brucellosis and
  tuberculosis (annual tuberculin testing)
• strict hygienic conditions regarding local
  equipment (accommodation, local storage of milk),
  animal husbandry, good practice, cooling of milk,
  and cleaning/disinfection of material
• well maintained register of the health of
  individual consignments and identification of
  livestock 

13
Current Regulations in France

• Raw milk is a category of "foods that have not
  undergone decontamination treatment or are
  susceptible to recontamination after treatment
• Listeria monocytogenes will be absent at the time
  of production, and not exceed 100 organisms per
  gram at the time of consumption

14
The Alternate Story
15
The Case For Untreated Milk by Dr. B. M. Pickard,
The University of Leeds

• There is no doubt that heat-treatment
  pasteurization is detrimental to milk
• Evidence shows that untreated milk has a higher
  nutritional value providing more available
  vitamins and minerals than pasteurized milk
• It contains anti-infective agents which can both
  restrict the growth of contaminating bacteria in
  the milk and give the consumer protection
• Not at least, it has a better flavor, with none
  of the deterioration in quality caused by heat
  treatment.

16
Capital Press, the Pacific Northwests Premier
Agricultural Newspaper, May, 2004

• The increasing concentration of the dairy
  industry is leading to the demise of small
  family-owned dairy farms and the domestic dairy
  industry, said dairy farmers from around the
  nation who met with New York Attorney General
  Eliot Spitzer
• The dairy farmers, who came from throughout the
  Northeast and as far away as Wisconsin and
  California, called on Spitzer to take the
  national lead and begin investigating industry
  consolidation in New York for possible antitrust
  violations.

17
The Association Fromages de Terroir, France

• At least 50 cheese varieties have disappeared in
  the past 30 years and many more are on their way
  out
• EU regulations are strangling the production of
  cheeses made with unpasteurised milk
• "Pasteurising makes for bland and mediocre
  cheese, but because of unfounded hysteria over
  bacteria such as listeria, which is not dangerous
  except to particular vulnerable groups, we are
  killing a fabulous product."

18
Weston A. Price Foundation Promotes Raw Milk

• This bases its reputation on the teachings of
  Weston A. Price, a dentist working in Cleveland
  in the 1930s who claimed that raw milk is
  healthier. dentist who visited 14 cultures and
  studied the impacts of their traditional diets
• The Weston A. Price Foundation is lead today by
  Nancy Fallon, a frequent speaker at organic
  conferences and other holistic health and
  alternative agriculture events

19
Weston A. Price Foundation Promotes Raw Milk

• She says Both raw and pasteurized milk harbor
  bacteria, but the bacteria in raw milk is the
  healthy bacteria of lactic-acid fermentation
  while the bacteria in pasteurized milk is the
  bacteria of spoilage.

20
Weston A. Price Foundation Promotes Raw Milk

• This is vehemently disagreed with by Dennis Avery
  who is a senior fellow for Hudson Institute in
  Indianapolis and the Director of the Center for
  Global Food Issues. He was formerly a senior
  policy analyst for the U.S. Department of State
• He is opposed to any organic or natural food
  group because he feels there claims are not
  justified

21
California Court Ruling Against Alta Dena Dairy

• The Superior Court found in 1989 that
• (a) "overwhelming evidence proved that
  Alta-Dena's raw (unpasteurized) milk frequently
  contains dangerous bacteria that can cause
  serious illness"
• (b) the company must stop its false advertising -
  selling and promoting raw milk as healthier

22
The National Health Council Against Health Fraud

• "The evidence is clear. Milk is a wholesome food,
  but there is nothing to be gained from drinking
  it in its raw, natural form. (Raw milk) poses a
  serious health risk to significant segments of
  the population. Only pasteurized milk should be
  sold for general public consumption."

23
Public Health Veterinarian Coalition Committee

• Recommends that only pasteurized milk/products be
  consumed or sold
• Many human pathogens have been documented in raw
  milk (e.g., Salmonella, Campylobacter, Yersinia,
  Listeria, Brucella, E. coli).
• Consumption of raw milk products has been
  identified as an important risk factors for E.
  coli 0157H7.
• Pasteurization of milk/products prior to sale is
  not required in all states

24
Wisconsin Cow Leasing Program Ended in Illness

• Since the sale of unpasteurized milk is illegal
  in Wisconsin, farmer Tim Wightman of Hayward sold
  shares in his cows, so the milk belonged to the
  share owners
• Wisconsin organic dairy farm has been forced to
  end a complex cow-boarding scheme that enabled
  250 shareholders to get otherwise-illegal raw
  milkbut not before 70 people were sickened by
  Campylobacter

25
Ontario Rules Against Cow Leasing Program

• Ontario government to allow farmers to drink
  unpasteurized milk while claiming that it would
  endanger public health for consumers to do the
  same 
• Ontario Board decided against lease-a-cow
  program, where consumers paid them for an
  animal's feed and upkeep, and in return gained
  access to raw milk and milk products

26
Ontario Rules Against Cow Leasing Program

• One farmer pleaded guilty to charges of selling
  unpasteurized milk
• he was fined 3,500 and ordered to dismantle the
  dairy operation within 30 days
• almost immediately, the insurance company
  cancelled the Schmidts' liability and fire
  insurance, and no other company would take them
  on.
• caught in an impossible situation, they were
  forced to sell their herd

27
The Question

• Is this position is still valid for an
  industrialized world where there is ample supply
  of relatively cheap milk and we have the ability
  to eliminate infectious foodborne disease?
• Or do we let a small group of people have the
  choice of a product they want whether or not
  there are good scientific arguments for it?

28
Some Perceptions
29
Regulation of Milk Sanitation Is Contested (Ten
Eyck, 2004)

• Claimed advantages of pasteurization
• Reduce mortality and morbidity
• do we know much about m/m due to milk _at_ 1900
• Delivered in sanitary containers from licensed
  dairies
• First step toward large scale dairy farms,
  dairies, and dairy industry 
• Others claimed disadvantages
• Destroys some of nutritional values (vitamins)
• Diminishes organoleptic values
• Makes it very difficult for farmers to sell their
  own milk to consumers
• Makes it difficult for farmers to form dairy
  cooperatives to sell their own milk

30
Population Surveys in England and Wales

• England and Wales decided to conduct a survey of
  its population on a ban on raw milk consumption
  as recommended by the UK government through its
  advisory committee
• 5,000 such responses were received in England
• 500 responses were received in Wales from
  consumers and producers objecting to the proposed
  ban
• Only 20 responses in England and 2 in Wales
  supported the proposed ban
• Most of the responses supporting a ban were from
  public health professionals

31
Association of Unpasteurized Milk Producers and
Consumers

• ? Evidence shows that heat treatment has
  detrimental effect on taste and on nutritional
  value
• ? More work is needed on effect of heat treatment
  on allergic reactions
• ? That untreated milk contains anti-infective
  agents which protect against infectious disease,
  and that these are destroyed by heat-treatment
• ? That untreated milk is sometimes wrongly blamed
  for outbreaks of foodborne illness, and that
  other foods are far more likely to be the vehicle
  of infection

32
Association of Unpasteurized Milk Producers and
Consumers

• ? That pasteurized milk can be contaminated with
  pathogens
• ? That the way ahead is not to ban, but to ensure
  that untreated milk contains the lowest possible
  levels of bacteria, and that it has been proved
  that farmers can produce clean milk. Therefore,
  though it is reasonable to penalize those with
  poor hygiene standards, it is wrong to suggest
  that all milk should be heat-treated because of
  these isolated outbreaks

33
Campaign for Real Milk

• ? Retail raw milk of higher quality than much
  milk sent for pasteurization because of controls
  on production
• ? Accepts presence of pathogens but claims
  infection from these minimal, and that raw milk
  carries beneficial anti-microbial agents
• ? Various health claims for raw milk, including
  higher vitamin content than pasteurized milk,
  immune system-strengthening enzymes, and reduced
  allergenicity, and argues that there are health
  concerns associated with heat treated milk (such
  as bowel disorders)

34
Campaign for Real Milk

• ? Has legal advice that a ban would be contrary
  to EU law, and that current controls may also be
  incompatible with EU law
• ? States that in the event of a ban, consumption
  of imports and milk from house cows would
  increase, increasing the risks to health
• ? Opposes a ban and supports better labeling
  option, but would want to see claimed health
  benefits also included

35
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36
United Kingdom

• EU legislation allows national rules prohibiting
  or restricting the placing of the market within
  its territory of raw milk or raw cream intended
  for direct human consumption
• The vast majority of milk consumed throughout the
  UK is pasteurized
• Each UK country has a different approach
• Scotland has a total ban
• England and Wales and Northern Ireland allows
  some raw milk consumption
• Surveys reopened issue

37
UK ADAS Survey in 1995/96

• Of 1591 samples, over 60 of the samples taken
  contained indicators of faecal contamination
• In addition, 7 of samples contained
  Staphylococcus aureus, 2 contained Listeria
  monocytogenes, and one sample contained
  Salmonella
• Another study detected Campylobacter in 6 of a
  total of 985 samples

38
The Public Health Laboratory Service (PHLS)
Survey 1996/1997

• Of 1132 raw milk samples, 3.7 contained various
  pathogens including E.coli O157 (3 samples),
  Campylobacter (21 samples), and Salmonella (5
  samples)

39
UK Advisory Committee on Microbiological Safety
of Foods

• In 1997, the ACMSF expressed concern that the
  surveys showed that raw cow drinking milk carried
  significant amounts of micro-organisms indicative
  of fecal contamination, as well as, in some
  cases, foodborne pathogens
• The Committee concluded that the sale of such
  milk in England, Wales and Northern Ireland
  should be banned, as it already was in Scotland

40
Organic Associations and Farmers

• ? Frustration at further consultation so soon
  after the result of the previous exercise, with
  no reason to believe opinion has changed
• ? States risks have reduced since controls
  strengthened
• ? States that presence in milk of microorganisms
  indicative of fecal contamination does not
  necessarily indicate a health risk, and that
  pasteurization destroys, nutrients, enzymes and
  other anti-bacterial mechanisms as well as
  pathogens

41
Organic Associations and Farmers

• ? Notes belief held by some that homogenization
  associated with increased risk of heart disease,
  though notes that evidence is inconclusive, and
  that unpasteurized milk is one of the few choices
  available to people who want non-homogenized
  milk
• ? A ban would drive sales underground, increasing
  the risk, and would damage organic dairy
  producers
• ? Believes in freedom of choice, and states that
  unpasteurized milk contains more vitamins than
  pasteurized, and also contains microbes that
  build immunity

42
Organic Associations and Farmers

• ? Argues that figures on foodborne illness show
  that milk (including unpasteurized) is safer than
  many other foods (such as burgers, eggs)
• ? States that strict controls already apply to
  unpasteurized milk, suggests that if there is a
  problem with individual producers, powers exist
  to tackle them
• ? Believes that this should be considered in
  wider context of the impact of intensive farming
  methods which create many potential health
  problems, and that FSA should be promoting
  alternatives to such methods

43
Arguments Counter the Raw Milk Advocates

• Freedom of choice is a political, philosophical
  or emotional matter that largely ignores the
  evidence of hazard and risk
• Appreciation of risk is often poor among the
  public, even among those who are especially
  susceptible (Heathcock et al 1998)
• There is loss of some nutritional factors but
  these are readily available from alternative
  sources in the normal diet, without the need for
  supplementation (Potter et al 1984)

44
Perceptions for Drinking Raw Milk

• ? It tastes better than pasteurized milk which is
  bland and has much goodness removed
• ? Knows where it comes from (local supplier), and
  values its traceability
• ? Pleased that it is tested regularly
• ? Wishes to retain freedom to choose approved
  retail raw milk (green top)
• ? Values freedom to be able to choose an
  alternative
• ? Purchases from local supplier, values
  traceability this offers

45
Perceptions for Drinking Raw Milk

• ? Believes green top builds immunity, and argues
  that there is evidence that overprotecting makes
  us more susceptible to germs and to allergies
• ? Accepts there is a risk but believes it to be
  insufficient to warrant a ban
• ? States the market is small, those who consume
  unpasteurized milk choose to do so understanding
  the risks involved

46
Perceptions for Drinking Raw Milk

• ? Travels to buy organic untreated milk (objects
  to term raw) and cheese says it is organic,
  better quality and the source is known
• ? Argues that heat treatment will eventually lead
  to emergence of heat resistant pathogens
  (compares to emergence of superbugs in hospitals)
• ? Sees main issue as freedom of choice supply
  already very restricted, and consumption could
  never be stopped completely

47
What Are the Arguments in Favor of Raw Milk?

• These are primarily
• the perceived organoleptic superiority of the
  raw product
• health and nutritional benefits (that heating
  destroys beneficial nutrient factors)
• that raw milk has inherently improved keeping
  quality or anti-bacterial properties
• freedom of choice

48
De Louvois Rampling. Brit Med J 1998

• "If the cow had been designed with HACCP for the
  dairy industry in mind it is unlikely that the
  udder would have been placed where it is."

49
Availability of Raw Milk Where Do We Go from
Here?

• Are these the choices?
• Total ban
• Unlimited access to raw milk
• Controlled raw milk supply with herd testing
• Retail sales with labeling and education
  indicating the risks
• Shared/leased cow supply permitted
• Farmers families only

50
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51
Recommendations for Control of Raw Milk
Consumption in Scotland

• Scotland A ban was introduced in 1983 because of
  illnesses associated with raw milk
• between 1970 and 1982 some 3,500 consumers were
  affected in 50 outbreaks of milk-borne Salmonella
  infections from raw milk with 12 fatalities
• extend current total ban on raw cows drinking
  milk to ewe, goat and buffalo milk

52
Recommendations for Control of Raw Milk
Consumption in England

• England allows raw milk sales only from
  registered milk production holdings (at the farm
  gate or in a farmhouse catering operation) or by
  distributors and milk roundsmen consumption and a
  label
• This milk has not been heat treated and may
  therefore contain organisms harmful to health

53
Recommendations for Control of Raw Milk
Consumption in Wales

• Instead of a ban, tighter controls, including
  stricter labeling
• This milk/cream has not been heat-treated and may
  therefore contain organisms harmful to health.
  The Food Standards Agency strongly advises that
  it should not be consumed by children, pregnant
  women, older people
• In addition, more frequent inspection and
  microbiological sample testing
• Official microbiological sample testing at
  production premises now takes place four times
  per year and official inspections of registered
  raw cow milk production holdings take place at
  least annually

54

• 14       15-16  association statements against
  raw milk17-18  price foundation supports raw
  milk19       dennis avery statement I would
  drop this avery is a notorious industry
  shill20       wisconsin cow leasing scheme
  ended in illness but leasing continues in
  wisconsin, so need to separate general
  arrangement from specific occurrence of
  illness21       ontario policy allow farmers
  to consume, not allow cow leasing22
        ontario enforcement puts farmer out of
  business23       eu and uk policy I would make
  a separate slide for the eu24-25  uk surveys of
  microbial contamination26       uk advisory
  committee recommend ban27       survey of public
  opinion in england/wales overwhelming support raw
  milk28-37  raw milk associations outline
  benefits should these not be up with
  17-1838-40  perceptions of raw milk not clear
  where these come from is this our summary of
  28-3741-42  arguments for and against47
        future choices

55

• Historically, milk was drunk raw or preserved
• Raw milk sours because of natural lactobacilli
• Cultures that drank milk dealt with spoilage and
  long term storage in several ways
• Consumed immediately or boiled for later use
• Yoghurt, cheese, buttermilk, sour cream
• Pasteurization has two functions
• Kills spoilage organisms that sour milk
• Kills pathogens that can cause serious illness

56
Outcome of Contestation

• Only retail sales are regulated not farm family
  consumption
• But some U.S. states, and European countries
  allow sale of raw milk but regulate farm
  production conditions
• Some states allow consumers to own part of a cow,
  and to receive milk from their part of the cow
• Norway allows farmers to make raw milk cheese
  because cannot deliver milk to dairy during
  winter
• In every country a percentage of consumers demand
  access to raw milk depends on how agrarian the
  country is controversy extends to cheese made
  from raw milk
• U.S. regulations allow raw milk cheese if aged
  more than 60 days

57

• France allows if dairy farm meets sanitary
  standards
• Queso fresco popular in Latino/Hispanic
  culture Bangladesh and other developing
  countries provide current examples of some
  aspects of historical system
• Need male cattle for traction for agriculture and
  transportation
• Surplus milk from bull mothers can be consumed by
  humans
• Vary in terms of how much meat want to harvest
  from the system
• Only parts of tropical regions provide grassland
  to support surplus milk production, e.g., Kenya

58

• Raw milk and its products raise a set of
  questions for progressive industrial and
  post-industrial societies
• What is the proper role of the state in
  protecting consumers from foodborne illness
• 1) susceptible subpopulations
• 2) subpopulations lacking adult decision making
  capacity
• 3) technological capacity in the society
• 4) supply of the relevant raw material

59
What Criteria Should Guide the State in Choosing
Specific Instruments to Accomplish Its Policies
(Proscription, Inspection, Education)

• What latitude should be allowed to consumers to
  choose foods that are
• 1) relatively hazardous
• 2) more hazardous than they have to be

60
How Should a Society Make These Decisions?

• Possible criteria
• 1) science
• 2) risk analysis
• 3) benefit-cost analysis
• 4) reversibility (e.g., sunset provisions)
• 5) values
• These questions could form the basis for an
  entire session in their own right . . . in our
  presentation today we will focus on consumer
  perceptions and attitudes concerning raw milk
• Both raw milk and pasteurized milk are sources of
  foodborne illness

61

• Although milk is not universal, it is one of the
  most widely consumed foods that humans get from
  other animals  get map from harris chapter
• Evolutionarily, milk is a complete and well
  balanced food for infants of the species that
  biological verity has been extended to a view
  that milk is the ideal food for humans,
  particularly to sustain growth in children, fetal
  growth in pregnant women, and milk production
  during lactation and that natures most perfect
  food 

62

• Historically, milk was drunk raw or preserved
• Raw milk sours because of natural lactobacilli
• Cultures that drank milk dealt with spoilage and
  long term storage in several ways
• Consumed immediately or boiled for later use
• Yoghurt, cheese, buttermilk, sour cream
• Pasteurization has two functions
• Kills spoilage organisms that sour milk
• Kills pathogens that can cause serious illness

63
Origin of Microbial Contaminants

• The national dietary surveys do not have data on
  consumption of pasteurized and raw milk
  separately
• The number of outbreaks attributed to raw milk in
  countries reporting such diseases is very small
  but that is partly because the consumption of raw
  milk in those countries is very small and would
  normally only affect a few people from one or two
  cows

64

• Possibility of acquired immunity to zoonotic
  pathogens through care of farm animals
• picture from europe of two story
  farmhouse Pasteurization of milk developed in
  mid 1800s
• Time-temperature combinations allowed destruction
  of Mycobacterium tuberculosis and other pathogens
• Pasteurization gradually spreads through
  industrialized, urbanized western societies
  although not used universally in any country
  including France

65
Traditional View of Milk Practiced in Bangladesh
Today

• Many policies exist to increase milk production
  throughout the country, through government dairy
  farms or private dairy farms
• The main objectives of these policies are to
  distribute raw milk at lower cost and to provide
  calves at marginal cost to poor farmers
  interested in rearing dairy animals

66
Traditional View of Milk Practiced in Bangladesh
Today

• It is well known that milk is an ideal food for
  humans, particularly to sustain growth in
  children, fetal growth in pregnant women, and
  milk production during lactation
• It has also been described as natures most
  perfect food
• For the newly born infant or animal, mothers
  milk is a complete and well-balanced food

67
Farmhouse Cheese Producer

• ? Believes in freedom to choose to consume foods
  beneficial to good health
• ? Believes pasteurization is linked to heart
  disease
• ? Notes that France, where unpasteurized milk is
  more widely available, is one of the healthiest
  countries in the world
• ? Believes a ban would damage the image of Wales
  as a quality food producer
•  

68
British Goat Societyand Producers

• ? Argues that pasteurized milk can also cause
  illness at least unpasteurized milk carries a
  warning
• Also states that pasteurization reduces
  nutritional benefits of milk
• ? Small scale producers cannot afford
  pasteurization equipment, but their product is
  valued by local consumers

69
British Goat Societyand Producers

• ? States outbreaks associated with raw goats
  milk are believed to be miniscule, and that
  properly produced goats milk should not require
  pasteurization
• ? Is opposed to a ban on retail sale, believes
  current warning is adequate but
• would accept better labeling, as they themselves
  advise pregnant women not to
• consume raw goats milk