When Food Kills: BSE, E. coli and Disaster Science

  • Hugh Pennington
Oxford University Press: 2003. 226 pp. £25, $35

There is a need for a book that explains to the public what food safety is all about and that gives policy-makers and managers the conceptual framework to make sensible judgements on 'food crises' when they hit the headlines. The preface of this book does not say for whom it is written or what its aims are. But it comes from Hugh Pennington, who led Britain's inquiry into the outbreak of food poisoning caused by the bacterium Escherichia coli O157 in Wishaw in Scotland in November 1996.

Sadly, although it is good in parts, the book does not explain the basis of food-safety assessment to the generalist. It lacks coherence and fails to develop clear lines of argument and explanation. Neither is it helpful to public-health specialists, general microbiologists or crisis managers, as it gives no advice that they could follow, nor any proposed framework for decision-making. It left me no clearer as to what Hugh Pennington thinks government or local authorities should do when faced with food scares, nor what he feels the public should think.

Instead, the book is a mêlée of good stories and fascinating anecdotes from the world of public health, loosely strung together around the stories of 'mad cow disease' (bovine spongiform encephalopathy, or BSE), new variant Creutzfeldt–Jakob disease (vCJD) and E. coli O157. The Wishaw food-poisoning outbreak was caused by lax hygiene in a local butcher's shop: 'ready-to-eat' products were contaminated with E. coli O157 from raw meat, and many people died. Occurring nine months after the BSE crisis, when the Conservative government had a fragile majority, the Pennington report made a number of recommendations, most of which have now been implemented.

But in When Food Kills, Pennington does not mention what to me was the really surprising outcome — that the local population sympathized with John Barr, the butcher involved, even when it became clear that he continued to distribute meat products after being identified as the source of the outbreak, thus causing many additional cases.

Why was the public so apparently illogical? Similar situations have arisen elsewhere, notably in connection with the risk of meningitis and permanent brain damage in the unborn fetus if a pregnant woman eats cheese contaminated with Listeria and contracts listeriosis. Another example is the public's negative response to the banning of 'beef on the bone' when concerns arose about BSE prions in lymph nodes. In all these cases, it seems that the public saw heavy-handed enforcement, not an attempt to protect them. As a former policy-maker in the area of food safety, I know how difficult it is to decide what the public will perceive as the correct balance between the freedom to ply a trade and the need to protect the public.

Since the Pennington report was published, Britain's Labour government has tried to address public concerns about food safety by setting up the 'independent' Food Standards Agency (FSA). This has had some initial success (see Nature 410, 867–868; 2001), although without being tested by a really big outbreak, it is probably too early to judge its performance. Food safety is a perennial obsession of the media, which tend to focus on food crises roughly every ten years: Salmonella in eggs and botulism from hazelnut yoghurt were key concerns around 1986, then interest fell away until BSE and E. coli O157 in 1996. I predict that 2006 or 2007 will be the critical year for the FSA, and hope they are doing some forward planning.

Another problem with When Food Kills is that Pennington starts his stories from the end (the cases of illness) and works back to the beginning. So we hear about vCJD victim Stephen Churchill developing an unsteady gait, about the Foré people dying from the prion disease kuru because they eat their ancestors' brains, and about the use of ultracentrifuges to show that the infectious agent in prions is unlikely to be a nucleic acid. Only then are we told about BSE in cattle and the facts related to the BSE epidemic. This leads to a confused feeling of 'so what', rather than 'so now I understand'. A number of regulatory and inspectorial issues provide some context but few conclusions. We range as far afield as the Three Mile Island nuclear accident, train crashes from the distant and recent past, and problems in old lunatic asylums, but no strong theme or message comes from it all.

I did enjoy his quotes from what must otherwise be dry reports of public inquiries. For example, when talking of the Salmonella food-poisoning outbreak at Wakefield's Stanley Royd Hospital in 1984, Pennington reports that the kitchens had been recognized as hazardous for many years, but that the public inquiry concluded that planning activities were a “remarkable example of what well-intentioned individuals can fail to achieve unless someone is charged with the responsibility of ensuring that careful attention to detail does not lead to a complete cessation of all activity other than the production of paper”. Unfortunately, today's well-intentioned emphasis on consultation and team-working probably exacerbates, rather than ameliorates, this problem.

Then Pennington quotes from the report of the inquiry into the 1966 Aberfan landslide disaster: “We found that many witnesses ... had been oblivious” to the dangerous state of the tips. “It did not enter their consciousness. They were like moles being asked about the habits of birds.”

Individually these stories are entertaining and provide memorable examples of the human propensity to ignore danger signals until it is too late. Indeed, one ends up surprised that disaster did not strike far earlier, or more often, given the sagas of negligence and misunderstandings detected once an investigation begins. But the overall impact is reduced by the lack of critical analysis of the cases, and unfocused and superficial discussion of the difficulties of keeping alert those charged with protecting us from rare but serious dangers.

Although overall the book disappoints, I know I will be using Pennington's quotes in my lectures in future. Indeed, one quote from the preface will remain with me. In Shakespeare's Twelfth Night, the foolish knight Sir Andrew Aguecheek anticipates the BSE crisis by saying “but I am a great eater of beef and I believe that does harm to my wits,” to which Sir Toby, his companion, replies: “No question.” The bard, as ever, was far ahead of his time.