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Raw Milk, a Potentially Risky Elixir

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There seems to be no middle ground in the debate over raw milk. On the one side, you have farmers happy to sell a product for $10 to $18 a gallon, and consumers who believe that they are purchasing a product that is not only more healthful but will also cure everything from allergies to autism. On the other side, you have public health officials defending the time-tested benefits of pasteurization as a way to make milk safe to consume.

But even though the argument appears to have two sides, the reality is as simple as it is undeniable: raw milk is seriously risky, and should be consumed, if at all, with extreme caution.

Health department officials in Minnesota this week have reported three, and possibly four, E. coli O157:H7 infections linked to drinking raw milk from a dairy in Gibbon. All of the sick were infected with a strain of bacteria that has the same "pulsed field gel electrophoresis" (PFGE) pattern, or DNA fingerprint. One infected child has now developed Hemolytic Uremic Syndrome (HUS), a potentially deadly complication.

Counting Minnesota, there have now been at least nine outbreaks of illness tied to raw milk since January 2010. The other states with outbreaks include Nevada, Utah (two outbreaks), New York, and Pennsylvania. There was also a multistate outbreak with illnesses confirmed in Michigan, Indiana, and Illinois. Washington has had two as well. And, even worse, these outbreaks involved at least three different pathogens: E. coli O157:H7; Salmonella, and Campylobacter. More specifically:

• In January, a dairy farm in New York was linked to five Campylobacter infections.
• Another outbreak of Campylobacter was reported in February in Pennsylvania. State health officials there said approximately ten people became ill after drinking raw milk. One of the ill developed Guillain - Barre Syndrome, became paralyzed, and is still hospitalized.
• In March, raw milk caused at least seventeen Campylobacter infections in Michigan, Illinois, Indiana.
• In April, Utah was the site of Salmonella and Campylobacter outbreaks tied to raw milk. The first cluster included nine reported cases of Campylobacter infection. The second cluster included six reported cases of Salmonella.
• Earlier this month, Nevada health officials reported that a child became seriously ill with a Campylobacter infection after eating homemade raw milk cheese that was illegally sold door-to-door.
• Washington has had two outbreaks both linked to the same dairy.

Over the last several years I have tried to bring some level of rationality to the debate over the consumption of raw milk. I first published on my blog a summary of the findings of a review of peer-reviewed literature on the topic of the "pros" of the consumption of raw milk. Most alleged benefits were anecdotal, with a reduction in allergies as the only scientific observation. I then posted about the "cons." The overwhelming "con" of drinking raw milk, according to the scientific literature, relates to the serious risk of infection, and the injury, disability, and death that result.

In trying to base the debate over the pros and cons of raw milk more firmly on facts, and not anecdote and emotion, I have found that the most instructive thing that I can do is to remind debate-participants of "real world" effects that drinking raw milk can cause. For example:

Chris Martin, then age seven, developed an E. coli O157:H7 infection in September 2006 following consumption of raw milk. He was hospitalized beginning September, suffering from severe gastrointestinal symptoms. Shortly thereafter, he developed hemolytic uremic syndrome (HUS). In an effort to properly treat his rapidly deteriorating condition, Chris was moved to multiple medical facilities, twice by life-flight. His HUS was remarkably severe, marked by prolonged renal failure, pancreatitis, and severe cardiac involvement. He required 18 days of renal replacement therapy. On two occasions his cardiac problems became so severe that he was placed on a ventilator. At several junctures, the possibility that he might not survive was very real. Ultimately he was hospitalized through November, after incurring over $550,000 in medical bills. Renal experts have opined that Chris is likely to develop severe renal complications in the future. These complications include end stage renal disease (ESRD) and kidney transplant.

Mari Tardiff was one of those sickened in the June 2008 outbreak of Campylobacter connected to raw milk. As a result of her campylobacter infection, Mari developed Guillain Barré syndrome, or GBS, a potentially fatal inflammatory disorder. By the time she was hospitalized in mid June, Mari was essentially paralyzed. Mari was intubated and placed on mechanical ventilation. For weeks on end, Mari's condition remained unchanged. She was heavily sedated, unable to move, and entirely dependent on mechanical ventilation for survival. In August, there were indications of slight improvement, and the very slow process of weaning Mari off mechanical ventilation began. At the outset, it was not clear that the process was successful. Through incredible effort on Mari's part, she was fully weaned off mechanical ventilation by August, and discharged to a rehabilitation facility. She spent more than two months at the rehabilitation facility diligently attempting to re-acquire the ability to speak, breathe, and move her arms and legs on her own. She was discharged home in November, still in need of essentially 24-hour care. Since that time, she has worked every day toward achieving her goal, as yet unreached, of walking again. Medical expenses to date exceed $1,000,000.

Nicole Riggs developed an E. coli O157:H7 infection in May 2008 from consumption of raw goat's milk. She was nine years old at the time. Nicole suffered from symptoms typical of E. coli O157:H7 infections - bloody diarrhea, cramping, and nausea - that quickly intensified and led to her hospitalization. Once hospitalized, Nicole developed renal failure, anemia, and thrombocytopenia (low platelet count) indicating that she was developing HUS. She was transferred to a Children's hospital and started on dialysis in order to save her life. She received dialysis for 18 days. Nicole's renal function slowly returned to the point that she was deemed healthy enough for discharge on June 1. After discharge, she remained under the care of a nephrologist. In addition, damage suffered during her HUS has required that her gall bladder be removed. Medical costs to this point exceed $180,000. As the result of damage to her kidneys suffered during her bout with HUS, Nicole is at significant risk for severe renal complications in the future.

Kalee Prue, a 27-year-old mother of one, became infected with E. coli O157:NM in June 2008, as the result of consumption of raw milk. Her symptoms began in early July, and intensified for several days. On two occasions, Kalee sought treatment in the emergency room. In July, it became apparent that she was developing hemolytic uremic syndrome (HUS). She was then admitted to the hospital with renal failure. She required plasmapharesis from July through August. Severe anemia necessitated repeated transfusions with packed red blood cells as well. By the time she was released from the hospital she had incurred over $230,000 in medical bills. Kalee has not recovered full renal function. She is at severe risk for long-term renal complications, including end stage renal disease (ESRD), dialysis, and transplant.

I certainly understand the desire of a farmer to sell a highly profitable product, just as I can understand the desire of consumers to make up their own minds about drinking raw milk. But farmers and consumers need to be fully informed, and the risks need to be fully understood. Because of the debate and the risks, I helped fund the building of www.realrawmilkfacts.com as a place where the pro's and con's of raw milk production and consumptions can be discussed against the background of scientific facts.

Bottom line, be informed. Please take a hard look at www.realrawmilkfacts.com.

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