Mycotoxins
13 THERE IS A CRACK IN EVERY THING
Radioactive Contaminants
SPICING UP THE LONG-TERM COMMITMENT
14 RISKS, RIGHTS, AND RIGHTEOUS EATING
Revisiting Risk
15 MONTEZUMA RULES THE WORLD
Deal with It
Further Reading
Acknowledgments
THIS BOOK IS ABOUT LOVE,
EATING, AND GETTING SICK.
AT LEAST one reviewer of this book’s first edition complained that she couldn’t find the sex and felt misled. She had, I think, quite a narrow view of love, of eating, and of sex. Others wondered if the title was Food, Sex, and Salmonella, or Food Sex and Salmonella, the latter apparently having somewhat risqué overtones. The first chapter explains all that, so I won’t spend valuable words expounding my theories here. Still, I did return to the literature and discovered that some foodborne diseases can be sexually transmitted. You will need to do a bit of work—to read the book—to find them. I hope that you will find this work pleasurable. Easy food, like easy sex, leads us down a path to waste and destruction of ourselves and the planet we live on. I have tried to make this book inviting but not too easy.
There are many hazards in the kitchen, including the hot, spraying fat, the risk of being burned to death as an unwanted wife in some parts of India, and, in the last few years in North America, a new phenomenon. A letter in the 1991 issue of the New England Journal of Medicine told the story of a healthy teenager who heated seven intact eggs in the microwave. As he removed them from the microwave and sat down at the table, six of the eggs exploded simultaneously, spraying him across the face; he suffered second-degree burns across his eyes, nose, and forehead. This book is not about that kind of hazard. It’s about infection and disease.
The danger of writing a book like this is that I will overwhelm you with facts about bacteria, viruses, and parasites and endless lists of foodborne disease outbreaks and cases. The facts are all very well and good, but unless someone makes sense of them, they are not of much use. The way scientists make sense of facts is by telling convincing stories. All the models and statistics and experimentally derived facts are ways of corroborating stories (or not). And the stories are never just about what scientists think.
Because foodborne diseases are of great, global, public health importance, everybody should be able to engage in lively, knowledgeable conversation about them so that we can have better-run restaurants, farms, kitchens, farmers’ markets, greengrocers, and butcher shops. We should all be telling stories about foodborne diseases, making jokes about them, and creating excellent public policies and programs to contain them or to live with them. Every story tells something about the storyteller. I was recently mocked by a business reporter for suggesting that ecomonies of scale, such as those espoused by Wal-Mart, were in some way responsible for pandemics of salmonellosis and avian flu. To me, his mocking suggested a profound ignorance of both biology and global trade. He might agree with storytellers who suggest that the problems of foodborne diseases can be easily solved if people was their hands and cook their food and that the increasing flows and changing patterns of bacteria and viruses around the globe are irrelevant (or uncontrollable).
As will become clear as you read this book, I believe that personal behavior is important but that this behavior is embedded in changing social, economic, and ecological patterns around the world. Hand washing and global warming and economies of scale are all important contributors to the changing nature of pandemics. We need all the evidence we can dig up and all the stories we can tell to make sense of that evidence.
In the course on foodborne diseases that I have been teaching for twenty years, I have students prepare what I call a dissemination project. They pick a group of people they think needs to know something about a particular foodborne illness or group of illnesses. Then they create an appropriate way to communicate with that group. Some of them come up with the usual sermons or tracts and posters that are the hallmark of much (really bad) public health communication. But over the years, they have also given me videos (“The Young and the Retching” comes to mind), educational dinners at synagogues and churches, websites, booklets for students and hitchhikers, and songs for the radio, day-care center, or campfire.
This book, like those dissemination projects, is less about the diseases themselves than about who gets them and why, what messages they are sending to us from the natural world of which we are a part, and how we can take pressure off the disease care system and create a more convivial world through how we eat.
Some basic material about foodborne diseases hasn’t changed much since 1992, when the first edition of this book was published. Our understanding about the way the human body gets sick, for instance, is pretty much the same now as it was twenty years ago, and several of the diseases, like botulism and salmonellosis, have been around so long that they almost seem “normal.” As Canadian singer Bruce Cockburn said, “The trouble with normal is it always gets worse.” Indeed, what we consider normal has changed; we no longer talk about eradicating salmonellosis, as some people used to, and botulism has re-established itself as a major disease in several countries of the former Soviet Union, giving people a deadly taste of what happens when we don’t invest in public health infrastructure or aggressively regulate private industry.
But the kinds of outbreaks and epidemics we see today are different from what they were twenty years ago. They are often bigger, usually more geographically dispersed, always more difficult to investigate. It is no great comfort to me that I said this would happen, and my critics scoffed, in the early 1990s.
Some new diseases have become discernible from the background noise in the last couple of decades. These are called “emerging diseases,” and there are whole journals devoted to them. The assessment of the burden imposed on society by foodborne illnesses has also changed; it’s worse than we thought. But there is also a convergence of understanding as to how we might begin to think about, and respond to, the whole complex interacting mess of eating, agriculture, urbanization, economics, and epidemics of foodborne diseases.
Well, the convergence is emerging among people who agree with me. But that is a whole lot more people now than it was two decades ago. You might even be one of them. You won’t know until you read this book, will you? Think of this book as my dissemination project. When you are finished reading, go to my website, send me an e-mail, and give me a grade. Then vote for a better world with your feet, your hands, and your menu for the week.
A word about the organization of this book. The chapters in the first section (“French Kissing on the First Date”) are an introduction to the personal and global dimensions of foodborne diseases. They give new reasons to think about food and sex and describe in some nauseating detail how food can make a person sick.
The second section of the book (“When She Stays for Breakfast”) deals with problems in food associated with bacteria, bacterial toxins, viruses, and parasites. This section begins with chapters on foodborne and waterborne infections (which usually show up in people primarily as diarrhea); these are followed by two chapters on intoxications by bacterial products, one focusing on the “usual” intoxications, in which vomiting is usually the prominent sign, and one on botulism, which has
