The public has until July 5 to tell the Food and Drug Administration (FDA) to require chain restaurants to disclose the amount of calories in beer, wine, and spirits, beverages that play a significant factor in America’s battle of the bulge.
In an effort to help consumers maintain a healthy weight and reduce health care costs associated with obesity, Congress passed legislation last year instructing the FDA to require chain restaurants to disclose calorie content for standardized menu items.  Alcoholic beverages are a significant source of calories in many Americans’ diets.  A bottle of beer, glass of wine, or a cocktail can have as many or more calories as a soft drink.  
Two-thirds of Americans are obese or overweight, conditions associated with increases in Type II diabetes, as well as heart attacks and strokes.  It is true that no single public health initiative like disclosing calories for standardized menu items will solve the nation’s obesity crisis.  But giving consumers basic nutrition information can at least allow those who care about their health to make informed choices about foods and beverages they consume away from home, which now account for as much as 50% of the average American’s food budget.  
Congress instructed FDA to issue compliance guidelines for restaurants, and then publish a formal regulatory proposal.   FDA issued guidelines several months after the legislation was enacted which plainly stated that alcoholic beverages served at chain restaurants were covered by the new law.  FDA’s position made good sense.   But then FDA flip-flopped — the agency issued a formal regulatory proposal exempting alcoholic beverages from calorie disclosure requirements.  (FDA also exempted movie theater popcorn, which was originally covered by the agency’s guidelines).
The agency’s excuse for excluding alcoholic beverages is that it lacks authority to require calorie disclosures next to listings of beer, wine, and liquor on chain restaurant menus.  FDA claims another government agency within the Treasury Department has been working on a proposed regulation that would require disclosing the amount of calories on beer, wine, and liquor labels. But the Treasury Department has been moving at a turtle’s pace, pondering the issue for more than seven years.  While Treasury retains general authority over what is printed on alcoholic beverage labels, it never even considered requiring calorie disclosures for restaurant menus.  Congress gave that responsibility to the FDA.  
Consumer Federation of America (CFA) and other consumer groups hope that FDA ultimately covers alcoholic beverages in the agency’s rules for menu labeling at chain restaurants and that Treasury requires calorie, alcohol per serving and other disclosures on bottles and cans.  The two steps would be complimentary, and would benefit consumers.  If Treasury finalized its proposed rule requiring calories and other important information on alcoholic beverage labels, restaurants would have a much easier job complying with any FDA requirement to disclose calories on menus, as the information would be readily available. However, that doesn’t mean one agency should wait for the other. Both agencies need to act. 
Congress clearly intended FDA to require menu labeling for alcoholic beverages, a requirement that is no different than calorie disclosure for meat and poultry dishes served at restaurants, as is intended in the menu labeling law.  Like alcoholic beverages, the labels of meat and poultry sold in stores are regulated by a different agency, the U.S. Department of Agriculture.  But when it comes to calorie disclosure for burgers and chicken on chain restaurant menus FDA has not questioned its own authority and has assumed responsibility as Congress intended.
The FDA needs to stop punting and should require calorie information for alcoholic beverages on chain restaurant menus.  —————————————–
Chris Waldrop is the director of the Food Policy Institute, Consumer Federation of America

Like most people, I wear a lot of different hats — mom, wife and what I am most known for — food safety advocate. I am also wearing another hat that I am hoping to put on a shelf by the end of the summer — graduate student. Before I was tragically thrust into the world of food safety, I was a master’s level statistician and had spent my career working in clinical research finding new treatments for schizophrenia, high cholesterol and other health issues. After I became involved in food safety, I realized that if I wanted to be viewed as more than a grieving mom, I needed to take my education up another notch. So, I went back to school to get my doctorate in Environmental Health — in Molecular Epidemiology to be exact.
“What’s that?” you may ask. Well, when it comes to food safety and foodborne illness, molecular epidemiology is critically important. It is the backbone of outbreak investigations and foodborne disease surveillance. Molecular epidemiology uses molecular techniques to study the impact of genetic and environmental risk factors on the causes, trends and prevention of disease. In less scientific terms, it means using DNA to find out what causes disease and what can prevent it. Basically, epidemiologists are disease detectives, and molecular epidemiologists use genetic information to do their detective work.
Over the past weeks, as we watched the E. coli outbreak in Europe unfold, there has been a lot of commentary on the efficiency and effectiveness of the European and German responses. I read criticisms of the amount of time it took to identify the outbreak, the premature announcement that cucumbers were the source, the lack of a definitive source, and so on. As I was reading, it was clear that many people do not understand the challenges that epidemiologists face in investigating foodborne illnesses. As an epidemiologist-in-training, I want to share with you a crash course in epidemiology. Welcome to Foodborne Illness Investigation 101.
Investigating foodborne illness is a really tough thing to do. It takes a lot of time, rarely follows a linear path and often is unsuccessful. It’s not surprising, since the deck is stacked against the investigator. When most people are sickened with foodborne illness, they immediately assume that the last thing they ate made them sick. If only it were that easy. Most likely it was something eaten several days before. For E. coli, it usually takes 3 to 10 days for symptoms to appear. For listeria monocytogenes, it can take up to 60 days — that’s right, two months.
Of course, most people don’t head to the doctor right away. Think about it. How sick would you have to be to go to the doctor and have a stool sample taken? Once the stool sample was taken, it would have to be sent to the lab and cultured which takes another couple of days — assuming the physician ordered the right test. Many foodborne illness tests are not automatically done — even though many physicians assume that they are. Once the culture is complete, the physician and/or laboratory are often required to report positive results to public health officials but, again, there are often delays.
(Maybe now you can see why the foodborne illness numbers are just estimates. Public health officials really only hear about the sickest people — the tip of the iceberg.) So, by the time you went to the doctor, had the lab test run, and public health officials were notified, the question is more likely what did you eat two to three weeks ago (and where). I’m sure you would be hard put to remember.
Enter the foodborne illness detective a.k.a. state or local health department epidemiologist. The bacteria have at least a two-week head start, and somehow the epidemiologist is expected to get ahead of it immediately. The investigation starts with an extensive interview with the patient about everything they ate, where they went, how many animals and sick people they had contact with, etc. The questionnaire is probably 10 pages long and takes a lot of time to complete. Meanwhile, a microbiologist will run additional tests so the genetic fingerprint of the bacteria can be uploaded into CDC’s PulseNET database to see if it matches other cases. Of course, entering the data into PulseNET is voluntary — completely voluntary. And since everyone is overloaded with work due to state budget cuts, it may take a while to get around to it even with the knowledge that timely entry into PulseNET is critical to identifying outbreaks. In fact, it’s how the 2006 spinach and 2009 peanut butter outbreaks were identified.
A couple of days later CDC announces a national outbreak related to the strain the epidemiologist uploaded. CDC hosts a conference call. All the people sickened have to be re-interviewed, because every state uses different questionnaires and the data can’t be combined to do the analysis that will help identify a source. (A while back, there was an effort to get all the states to use the same form, but only seven agreed to participate.) Re-interviewing patients will take time — especially if the state has a de-centralized surveillance system. Investigation activities must be coordinated across different divisions and branches of government so it is not uncommon for “turf” issues to arise.
Local health departments might be asked to re-interview the patients using the standardized form. They too are understaffed and overworked but may be reluctant to seek state or federal assistance with patient follow-up, citing confidentiality concerns. There might also be a sense that patients will be more receptive to additional inquiries from a local health department person with whom they have spoken with previously. These factors can contribute to delays in the investigation progress. Remember the 2009 Salmonella tomato/pepper outbreak that lingered on for nearly three months? One of the reasons it took so long to find a source was that local health departments refused to share information with their state health departments, and both refused to share information with CDC. It’s hard to do detective work if you don’t know where the victims are.
Now, if you are lucky, you are an epidemiologist in the state of Minnesota, where you’ll be able to take advantage of a centralized food safety system and Team Diarrhea (yes, it’s really called that). Team D — made up of graduate students from the University of Minnesota’s School of Public Health — swings into action at their command center and conducts standardized phone interviews. It’s super efficient and, once they get involved, Minnesota usually figures out the source. It is unbelievable that Team D is on the chopping block in Minnesota’s budget debate. Actually, every state needs a Team D.
Hopefully, by now, you are beginning to see why it can take so long to “solve” an outbreak and why so many end up being a “cold case” with only a list of potential suspects. As with regular detective work, centralized systems work in your favor and de-centralized ones increase the likelihood that you’ll end up with no clear-cut answer. The recent outbreak in Germany is a perfect example. An editorial in Nature published last week explains how Germany’s complicated, de-centralized surveillance system impacted that country’s ability to respond to the E. coli outbreak.
Sadly, the German system sounds a lot like the system we have in the United States. The Germans have two federal ministries, two federal technical institutes, and 16 state ministries involved in foodborne illness surveillance. In the United States, there are 15 federal agencies and thousands of state and local agencies involved. In both countries, the coordinating agencies — CDC and RKI — receive information indirectly and have no direct authority over the sources of their information. At least the United States has PulseNET — for now. Already under-funded, PulseNET is in serious jeopardy as state governments furlough staff and/or choose not to replace staff who leave. Without timely data being uploaded into the database, PulseNET cannot identify outbreaks and prevent others from being sickened.
Early on, some lamented that if a definitive source was not found the German outbreak would be a lost opportunity to learn about the epidemiology of foodborne disease. I disagreed. One of the lessons learned is that sometimes centralization and standardization is a good thing — especially if you are a disease detective.
———————————
Barbara Kowalcyk is the CEO of the Center for Foodborne Illness Research and Prevention. She was voted the Huffington Post’s Ultimate Game Changer in the food category in 2010. This article was first published June 29, 2011 as “Welcome to Armchair Epidemiology: The How-To’s of Solving a Foodborne Illness Outbreak” on Huffpost Food on Huffington Post. Republished with permission.
—————————–

The following is a statement released Wednesday by Bill Marler, managing partner of the food safety law firm Marler Clark and publisher of Food Safety News:
In the face of recent E. coli and Salmonella outbreaks linked to sprouts, food safety advocate and attorney Bill Marler, managing partner of Seattle-based Marler Clark, is calling on seed and sprout producers to take a hard, realistic look at the danger their product poses to consumers. 
Though the month of June was dubbed “International Sprout Health & Wellness Month” by the International Sprout Growers Association (ISGA), the world has seen at least three sprout-based foodborne illness outbreaks this month, including the deadliest in history: the E. coli O104:H4 outbreak in Germany that has killed nearly 50, landed over 800 in the hospital with hemolytic uremic syndrome, and sickened 4,000. More recently, France has seen a cluster of E. coli O104:H4 infections related to sprout seeds, and in the U.S., an Idaho sprout farm has been linked to at least 21 Salmonella illnesses as of June 28. According to OutbreakDatabase.com there have been a total of four sprout-based foodborne illness outbreaks in 2011 and 48 since 1991.
“We’ve seen about 4,000 people get sick this year.  Another 44 have died because they ate sprouts, and I don’t think it is altogether clear what sprout growers are planning to do about it,” said Marler. 
In January of this year, Marler donated $10,000 to the ISGA for improving the safety of sprouts. In an interview with the agriculture news organization The Packer, ISGA president Bob Sanderson said Marler’s donation would help speed implementation of a food safety audit for sprouts and anticipated a start to the audit of February 1, 2011. However, in June the ISGA told Food Safety News the audit was still being developed.
In light of the most recent sprout-related outbreaks, Marler renewed his call on the sprout industry to put warning labels on sprout packaging.  
“If this were another product that wasn’t considered a healthy food, we as a society would have a much bigger issue with the atrocious food safety track record of sprouts, but because sprouts are considered healthy — the ISGA even touts them as a ‘wonder food’ – our first reaction isn’t to associate risk with consumption,” said Marler.
“Those of us entrenched in food safety know how dangerous sprouts can be, but the average person does not.  At the very least, consumers deserve to be given equal information regarding the risks and benefits of sprouts.  A warning label would provide this.”
According to the FDA, sprouts pose a special problem because of the potential for pathogen growth during the sprouting process.  
Marler specifically urges seed and sprout producers to adopt the following measures to prevent pathogen growth on sprouts and protect consumers:
1. Seed manufacturers must adopt good agricultural practices to limit bacterial contamination on seed plants.2. Seed manufacturers must adopt a chemical or other treatment on seeds to kill bacteria3. Sprout manufacturers must adopt good manufacturing processes that include the use of clean water, healthy workers and a hygienic environment.4. Sprout sellers must place adequate warning labels on all sprout containers informing consumers of bacterial and viral risks associated with sprout consumption