Is America at Risk?

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CHAPTER 1

IS AMERICA AT RISK?

Sari Edelstein, PhD, RD

Chapter Objectives After reading the chapter and reflecting on the contents, you should be able to: 1. Identify the concern for food safety and the presence of foodborne illness in the United States. 2. Articulate an understanding of the term “biotechnology” as it relates to genetically modified food. 3. Determine that food insecurity is a growing problem in the United States. 4. Recognize that the threat of agroterrorism/bioterrorism exists in the United States

Key Terms agroterrorism: Includes purposeful adulteration/poisoning of agricultural crops and the food supply to cause illness or death. biotechnology: Includes a gene slicing technique that enables scientists to insert genes into foods for the purpose of dealing with the environmental stresses the world now poses. bioterrorism: Includes purposeful adulteration/poisoning of food or food sources to cause illness or death. food insecurity: Relates to the access to wholesome, healthy foods. food safety: The pursuit of uncontaminated, unadulterated, clean, wholesome food that is fit for healthy consumption. foodborne illness: A disease that is carried or transmitted to people by food. Pathogens in food can generate infection, intoxication, or intoxification.

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genetically modified foods: Foods that have undergone gene slicing or gene replacement.

Introduction This book, Food and Nutrition at Risk in America: Food Insecurity, Biotechnology, Food Safety, and Bioterrorism, addresses the strengths and weaknesses of four paramount issues in America’s struggle to provide safe and adequate food and nutrition for all those living within its borders. As we leap into the second decade of the 21st century, we find that providing US inhabitants with “safe and adequate” food has become a daunting task. So daunting, in fact, that we might be on the verge of “crisis management” in our ability to protect our population from pathogens and chemicals that invade our food supply as well as our capability to supply enough affordable food to feed our people. Food and Nutrition at Risk in America takes a four-pronged approach to expose those areas in the food and nutrition domain that have become increasingly vulnerable to the provision of safe and adequate food and nutrition in the United States. These four areas of concern are: food safety, biotechnology and genetically modified foods, food insecurity, and agro/bioterrorism.

Food Safety Food safety includes the pursuit of uncontaminated, unadulterated, clean, wholesome food that is fit for healthy consumption. To feed the population safe food, the food should not cause illness upon ingestion or during the hours following ingestion. In short, safe food should not cause a foodborne illness, which is a disease that is carried or transmitted to people by food (FDA, 2006). Food safety can be threatened by biological, chemical, or physical hazards. In Section One of this book, biological foodborne pathogens, their etiology, and emerging pathogens in the US food system will be high- lighted for the reader. Disease-causing pathogens in food can generate infection, intoxication, or intoxification for unwitting con- sumers. These illnesses can cause morbidity and mortality at alarm- 54082_CH1_0001_0012 7/8/08 10:45 AM Page 3

Food Safety 3

ing rates. Table 1.1 indicates illness rates from biological foodborne illness in the United States. Table 1.2 gives an account of the current dollars spent by the United States in three of its major governmental offices—US Depart- ment of Agriculture (USDA), US Department of Health and Human Services (HHS), and Environmental Protection Agency (EPA)—on food safety programs. Table 1.3 lists the percentage of respondents who identified various pathogens as the top three causes of foodborne illnesses and the estimated percentage of US foodborne illnesses that were actually caused by those pathogens. Figure 1.1 depicts the surveillance rates from 1996 to 2004 of five major foodborne illnesses, and Figure 1.2 indicates the five types of Salmonella infection rates from those years. Chemical hazards in food are linked to paint, lubricants, clean- ing agents, and pesticides while physical hazards include broken glass, metal shavings, and plastic ties. These hazards should not be minimized in their importance of control in the food supply. Food and Nutrition at Risk in America will focus on biological hazards as the major source of foodborne illness in the United States.

Table 1.1 Average Annual Hospitalizations and Deaths for Gastrointestinal Illness by Diagnostic Category, National Hospital Discharge Survey, 1992 to 1996

First diagnosis All diagnoses Cause of enteritisa Hospitalizations Deaths Hospitalizations Deaths Bacterial (001–005, 27,987 148b 54,953 1,139 008–008.5) Viral (008.6–008.8) 82,149 0b 132,332 194b Parasitic (006–007) 2,806 82b 5,799 127b Unknown etiology 186,537 868b 423,293 5,148 (009, 558.9) Total 299,479 1,098 616,377 6,608

aICD-9-CM code. bEstimate unreliable due to small sample size. Source: Mead, P.S., Slutsker, L., Dietz, V., McCaig, L.F., Bresee, J.S., Shapiro C., et al. (1999). Food-related illness and death in the United States. Emerging Infectious Diseases Newsletter, Vol. 5, No. 5. Retrieved October 12, 2007, from http://www.cdc.gov/ncidod/eid/vol5no5/ mead.htm. 54082_CH1_0001_0012 7/8/08 10:45 AM Page 4

4 Chapter 1: Is America at Risk? ter a 238,917 Total b 0 0 0 0 0 900 600 2,000 3,500 EPA EPA 0 8,115 7,000 3,230 19,846 51,325 10,011 12,791 112,318 USDA USDA a 123,099 HHS 8 3,700 8 3,900 7 3,177 5 200 0 0 54 23,365 Projects Projects Dollars Dollars Projects Dollars Dollars Projects Projects Fiscal Year 2000, Dollars in 1,000s (Estimated) Year Fiscal Summary of Inventory for Federal Food Safety Research Food for Federal Summary of Inventory USDA Food Safety Research Information Office. (2005). Retrieved September 20, 2007, from http://fsrio.nal.usda.gov/. Information Office. (2005). Retrieved Safety Research Food USDA susceptibility of foodborne microbes organisms/illness Research focus Research Detection of foodborne hazards Control of foodborne hazards of foodborne microbesPathogenicity 16 7,400 Risk assessment: methods/data handling, distribution, and storageFood Economic analysis 0 0 Antimicrobial/antibiotic resistance/ Epidemiology of food-associated Total Funding levels for the EPA competitive grants program in fiscal year 2000 that is specifically targeted to drinking water patho gen 2000 that is specifically targeted to drinking water in fiscal year program grants competitive for the EPA Funding levels not been determined at this time. have research grant awards are actually made; splits reflect only Centers for Disease Control and Prevention (CDC) and Food and Drug (CDC) and Food are actually made; splits reflect only Centers for Disease Control and Prevention awards grant category. by dollars, and no totals are given (FDA) Administration This number includes $81,357 million for National Institutes of Health (NIH), whose research dollars are not allocated until af research number includes $81,357 million for National Institutes of Health (NIH), whose This Table 1.2 Table a b Source: 54082_CH1_0001_0012 7/8/08 10:45 AM Page 5

Biotechnology and Genetically Modified Foods 5

Table 1.3 Percentage of Respondents Identifying Each Pathogen as among the Top Three Causes of Foodborne Illness and Estimated Percentage of Foodborne Illnesses in the United States Actually Caused by Those Pathogens

Percentage of Estimated percentage of respondents listing it foodborne illness in United Pathogen among top three causes States caused by pathogen Salmonella 90 9.7 Escherichia coli 56 1.3 Staphylococcus 36 1.3 Shigella 32 0.6 Campylobacter 18 14.2 Listeria 16 Ͻ0.1 Hepatitis A virus 8 Ͻ0.1 Clostridium 8 1.8 perfringens Norwalk-like virus 5 66.7 Virusesa 467.2 Giardia lamblia 3 1.4 Streptococcus 2 0.4

aThis represents respondents who wrote in “viruses” only; it does not include those who specified Norwalk-like virus. Source: Jones, T.F., & Gerber, D.E. (2001). Perceived etiology of foodborne illness among public health personnel. Emerging Infectious Diseases Newsletter, Vol. 7, No. 5. Retrieved October 12, 2007, from http://www.cdc.gov/ncidod/eid/vol7no5/jones.htm.

Biotechnology and Genetically Modified Foods Biotechnology includes a gene slicing technique that enables scientists to insert genes into foods for the purpose of dealing with the environmental stresses the world now poses (Bren, 2003). Figure 1.3 illustrates gene slicing. The result is a genetically modified food that should be better able to withstand environmental stresses and provide people with higher quality and quantity of food. More than 50 genetically modified food products have been evaluated by the FDA and were found to be as safe as conventional foods, including canola oil, corn, cottonseed oil, papaya, potatoes, soybeans, squash, sugar beets, sweet corn, and tomatoes. Figure 1.4 depicts the percentage of 54082_CH1_0001_0012 7/8/08 10:45 AM Page 6

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FIGURE 1.1 Relative Rates Compared with 1996 to 1998 Baseline Period of Laboratory-Diagnosed Cases of Infection with Campylobacter, Escherichia coli O157, Listeria, Salmonella, and Vibrio, by Year—Foodborne Diseases Active Surveillance Network, United States, 1996 to 2004

2.0 Vibrio Salmonella Campylobacter Listeria E. coli O157

1.0

0.8 Relative rate Relative 0.7

0.6

0.5

1996–1998 1999 2000 2001 2002 2003 2004 Year

Source: CDC. (2005). Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food—10 sites, United States, 2004. (MMWR, Vol. 54, No. 14, pp. 352–356.) Retrieved September 20, 2007, from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5414a2.htm#tab.

genetically modified soybeans, corn, and cotton that now exist in our crop supply.

Food Insecurity Food insecurity encompasses many categories of persons within the United States, which include those who are food insecure without hunger and food insecure with hunger. Chapter 6 gives insight to the differences between these terms and how they are determined in the United States. As of 2002, the USDA reports that some 11% of US households experienced food insecurity (Nord, Andrews, & Carl- son, 2002). This is a rise from past years and represents a threat to US health. Figure 1.5 depicts the percentage of food insecurity by type in the United States. 54082_CH1_0001_0012 7/8/08 10:45 AM Page 7

Agro/Bioterrorism 7

FIGURE 1.2 Relative Rates Compared with 1996 to 1998 Baseline Period of Laboratory-Diagnosed Cases of Infection with the Five Most Commonly Isolated Salmonella Serotypes, by Year—Foodborne Diseases Active Surveillance Network, United States, 1996 to 2004

Javiana 4.0 Newport Heidelberg 3.0 Enteritidis Typhimurium 2.0

1.0 Relative rate 0.8 0.7 0.6 0.5

0.4

1996–1998 1999 2000 2001 2002 2003 2004 Year

Source: CDC. (2005). Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food—10 Sites, United States, 2004. (MMWR, Vol. 54, No. 14, pp. 352–356.) Retrieved September 20, 2007, from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5414a2.htm#tab.

Food and Nutrition at Risk in America will delineate some solu- tions for food insecurity through federal, state, and community assistance programs. While these programs are vital to the health of the US people, cost and cause must be analyzed further.

Agro/Bioterrorism Agro/bioterrorism includes purposeful adulteration/poisoning of food to cause illness or death. Although acts of aggression against the US food supply are not new, 9/11 made the potential a possible reality both within the United States and from outside perpetrators. The United States established the Bioterrorism Act of 2002 to delineate where threats would occur and our preparedness (USDA, 2002). 54082_CH1_0001_0012 7/8/08 10:45 AM Page 8

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FIGURE 1.3 Traditional Plant Breeding and Modern Plant Breeding (Genetic Engineering)

Traditional Plant A chromosome contains thousands of genes. Traditional plant Breeding breeding combines many genes at once.

New Variety Traditional Donor Recipient Variety (many genes are transferred)

ϫ ϭ (crosses) DNA

Desired Gene Desired Gene

Using traditional genetic modification methods, such as cross-fertilization, scientists can produce a desired trait, such as a hardier plant. But in doing so, they mix thousands of genes, requiring many attempts over many years to remove the unwanted traits that occur.

Newer methods of genetic modification, in the form of genetic engineering, are more precise and predictable—and faster. By controlling the insertion of one or two genes into a plant, scientists can give it a specific new characteristic without transferring undesirable traits.

Modern Plant Breeding Using plant biotechnology, a single (genetic engineering) gene may be added.

Desired Recipient New Variety Donor Gene Variety (only desired gene is transferred)

ϭ Isolate DNA Gene

Desired Gene Desired Gene

Source: Bren, L. (2003). Genetic engineering: The future of foods? FDA Consumer Magazine, November–December. Retrieved October 12, 2007, from http://www.fda.gov/fdac/features/ 2003/plantDNA.html.

The act includes the following five titles and can be found in com- plete form at http://www.fda.gov/oc/bioterrorism/PL107-188.html: Title I—National Preparedness for Bioterrorism and Other Public Health Emergencies Title II—Enhancing Controls on Dangerous Biological Agents and Toxins Title III—Protecting Safety and Security of Food and Drug Supply 54082_CH1_0001_0012 7/8/08 10:45 AM Page 9

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FIGURE 1.4 Top Three Genetically Engineered Crops in the United States (2003)

60 59.7

40 31.6 (acres in millions)

Genetically engineered crops 10

Soybeans Corn Cotton (81% of total (40% of total (73% of total soybean crop) corn crop) cotton crop)

Source: National Agricultural Statistics Service/USDA

Source: Bren, L. (2003). Genetic engineering: The future of foods? FDA Consumer Magazine, November–December. Retrieved October 12, 2007, from http://www.fda.gov/fdac/features/ 2003/603_food.html.

Title IV—Drinking Water Security and Safety Title V—Additional Provisions In addition to the policy making of the USDA, the FDA (n.d.) is working to prevent acts of bioterrorism through: • working with industry to reduce threats and contain outbreaks of foodborne illness • increasing risk-based surveillance of domestic and imported food • developing PrepNet food safety network • implementing the Bioterrorism Act of 2002 • increasing the ability to quickly identify outbreaks of foodborne illness • increasing participation in the first Internet-based food safety system 54082_CH1_0001_0012 7/8/08 10:45 AM Page 10

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FIGURE 1.5 US Households by Security Status, 2002

Food insecure, 11.1% Food insecure without hunger, 7.6% Food secure, Food insecure with 88.9% hunger, 3.5%

Source: Calculated by ERS using data from the December 2002 Current Population Survey Food Security Supplement.

Source: Nord, M., Andrews, M., & Carlson, S. (2002). Household food security in the United States, 2002. Retrieved October 12, 2007, from www.ers.usda.gov/Publications/FANRR35/.

Food and Nutrition at Risk in America will clarify the risk for the reader as well as the state of preparedness of the United States.

Issues to Debate 1. How educated do you think the public is about these topics at the present time? 2. Why do you think that the public is or is not informed about these topics? 3. How important is each of these topics? 4. Is the US government doing enough to solve the food and nutrition problems of the country? 5. Rate the importance of each topic against one another and place them in order of importance. Explain your results.

Web Sites US FDA/Center for Food Safety and Applied Nutrition www.cfsan.fda.gov/ FDA’s food biotechnology Web site www.cfsan.fda.gov/~lrd/biotechm.html 54082_CH1_0001_0012 7/8/08 10:45 AM Page 11

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List of bioengineered foods that have completed FDA consultation www.cfsan.fda.gov USDA’s report on household food security www.ers.usda.gov/Publications/FANRR35/ Bioterrorism and food safety www.foodsafety.gov/~fsg/bioterr.html Bioterrorism Act of 2002 http://www.fda.gov/oc/bioterrorism/PL107-188.html FDA’s role in bioterrorism http://www.fda.gov/oc/bioterrorism/role.html US Department of Agriculture Food Safety and Inspection Service http://www.fsis.usda.gov/PDF/Food_Defense_Plan.pdf

References Bren, L. (2003). Genetic engineering: The future of foods? FDA Consumer Magazine, November–December. Retrieved October 12, 2007, from http://www.fda.gov/fdac/features/2003/603_food.html Food and Drug Administration. (n.d.). FDA’s counterterrorism role. Retrieved October 12, 2007, from http://www.fda.gov/oc/bioterrorism/role.html Food and Drug Administration, Center for Food Safety and Applied Nutri- tion. (2006, April 25). Foodborne pathogenic microorganisms and natural toxins handbook (Bad bug book). Retrieved September 20, 2007, from http://vm.cfsan.fda.gov/~mow/intro.html Nord, M., Andrews, M., & Carlson, S. (2002). Household food security in the United States, 2002. Retrieved October 12, 2007, from www.ers.usda.gov/ Publications/FANRR35/ USDA. (2002). Bioterrorism act of 2002. Retrieved October 12, 2007, from http://www.fda.gov/oc/bioterrorism/PL107-188.html 54082_CH1_0001_0012 7/8/08 10:45 AM Page 12