According to the egg industry, the thousands of people sickened by eggs contaminated with Salmonella enteritidis have only themselves to blame. As USA Today reported:
“Consumers that were sickened reportedly all ate eggs that were not properly or thoroughly cooked. Eggs need to be cooked so that the whites and yolks are firm (not runny) which should kill any bacteria,” says Mitch Head, spokesperson for the United Egg Producers.
“Some people may not think of an egg as you would ground beef, but they need to start,” says Krista Eberle of the United Egg Producers’ Egg Safety Center. “It may sound harsh and I don’t mean it to sound that way. But all the responsibility cannot be placed on the farmer. Somewhere along the line consumers have to be responsible for what they put in their bodies.”
With more than 500 million eggs to date subject to recall for contamination, this effort to shift the focus to consumers’ behavior deserves scrutiny. Implicit in this shift is an attempt to absolve producers – and the government agencies charged with overseeing these producers and ensuring the health of our food supply – of responsibility. But there are many good reasons for our government to ensure the safety and security of the food we eat. Indeed, Congress has assigned this task to protector agencies such as the Food and Drug Administration precisely because most Americans want to go to their local grocery stores and know that the food sold there will be fit for human consumption.
The call for a shift in regulatory responsibility – away from the risk producers and toward the risk bearers – is reminiscent of a similar shift in the context of environmental contamination. There, as here, proponents of the shift argue that we can forego regulation that would actually reduce risk, whether by preventing or cleaning up contamination, if instead we convince those exposed to avoid risk by altering their practices and behaviors that expose them to risk. So, instead of curtailing the air pollutants that form ground-level ozone, they claim, we should issue “ozone alerts” telling people to stay indoors; instead of preventing mercury from contaminating our waters, we should post fish consumption advisories warning people not to eat particular species of fish caught in those waters. Proponents make the case for this shift, to what I term “risk avoidance” approaches, because they claim it will be cheaper, at least in the short term. But, as I have argued elsewhere, their case fails for several reasons.
Risk avoidance often aims at one target, but misses others. Here, the advice urged by the egg producers (and sometimes by the FDA) focuses on consumers’ behavior when they prepare or order eggs: “avoid ‘runny egg yolks for mopping up with toast’” “eggs need to be cooked so that the whites and yolks are firm.” Yet a large share of human exposure comes not from direct consumption of undercooked eggs, but from cross-contamination, instances in which raw egg used in one cooking task ends up contaminating other items in the kitchen, such as utensils, counters, sinks, and dish towels – which then come in contact with hands or other food items and, ultimately, end up being ingested. The admonition that people scrambling eggs for breakfast ensure that the egg whites reach 145-149 degrees F and the egg yolks reach 148-149 degrees F says nothing about the raw egg that drips on the counter where they set their toast.
Risk avoidance is notoriously ineffective, failing actually to achieve its stated goal of protecting human health. In order for risk avoidance to work, warnings and advisories must be received and understood, and, ultimately, behaviors must be changed. There is ample evidence, for example, that fish consumption advisories reach somewhere in the neighborhood of half their intended audience. Notably, people with limited English proficiency, people with less formal education, and low-income people tended to evince the least awareness of these public health advisories. It is obviously a grave failure for public health policy if half of the public is left unprotected, and all the more so if those left to fend for themselves are among our most vulnerable.
Even if this hurdle is surmounted – the message reaches and is understood by everyone – it is notoriously difficult to effect behavioral changes in people. It is just not the case that everyone, once informed, will stop fixing their eggs over easy. Some people will simply refuse to change their ways. But even for those who attempt to change, compliance with the warnings in this case is extremely difficult. The FDA does advise that in addition to thorough cooking, people clean cooking surfaces and utensils when using eggs. But research by Professor Doug Powell at Kansas State University has shown that, when people use raw eggs in the kitchen, raw egg ends up all over the place. While people can be advised, as he puts it, to treat raw egg “like hazardous waste” in their kitchens, this is very difficult to do in practice. According to Powell, people are “delusional at how good they are at handling food.”
Risk avoidance may also introduce risks. To the extent that consumers take steps to avoid the risks from eggs that are contaminated, they may adopt practices that subject themselves to a different set of risks. For example, people who attempt to comply with advice to avoid all but hard-boiled eggs may eat fewer eggs, in the process foregoing a valuable source of dietary protein.
Given the limits and failures of risk avoidance as a “regulatory” approach, we should resist this shift. Instead, we should arm our agencies with the authority and the wherewithal to see that our food is safe to eat, our air safe to breathe, and our waters uncontaminated. In FDA’s case, there is much room for improvement. Meaningful risk reduction would require, among other things, an FDA that had the power to mandate recalls, the authority to levy meaningful civil and criminal fines, and the ability actually to monitor and enforce safety standards. These standards, moreover, would entail measures to prevent contamination in the first place, whether by vaccinating hens (which has had impressive success in England), by pasteurization, or by other means. Finally, we would do well to reconsider our entire system of producing food, with an eye toward food safety, food security, and ultimately, sustainability.
One things is clear: when one purveys a product that is contaminated with a pathogen which has sickened so many and has the potential to kill (recall that nine people died from eating peanut butter contaminated with Salmonella enteritidis a few months ago), it is harsh to try to blame the victim.