Daniel Boone, Yogi Berra, the tsunami, and raw milk.

"This is like deja vu all over again."
Yogi Berra

Daniel Boone was said to have an i-credible ability to travel for hundreds of miles through dense forest and be able to remember exactly how to return to a particular point. He generally knew where he had been, how he got there, and how to get back to where he needed to be. We sometimes get too immersed in our work in environmental health to remember how we got where we are and how to get where we need to be.

On December 26, 2004, an undersea earthquake in the Indian Ocean triggered a tsunami that killed almost 250,000 people and displaced millions more. We all watched the tourist videos of the ocean receding and people moving forward to explore the bare seabed, only to be engulfed by the fast moving waves that seemed to have no end. The impact on Indonesian population centers was numbing. Days later, investigations were made of some of the remote islands populated by people who rarely came into contact with the outside world and lived without any of the technology that we feel is essential to our well-being. It was feared that the inhabitants of the Andamans islands would have perished in the face of such a massive natural disaster. Anthropologists were astonished to find that these tribal people had survived. They discovered that the elders of the tribes remembered the oral traditions of what happened when the ocean suddenly receded. The experiences of those long-lost ancestors told them that they needed to get to higher ground immediately. In other words, their history gave them relevant insight to deal effectively with a difficult situation in today's world.

We would do well to remember the wisdom of those who preceded us in environmental and public health. When I entered the field of environmental health almost 40 years ago, I took the Centers for Disease Control and Prevention (CDC) Study Course 3010 G, an introduction to the important matters involved in my new profession. Milk sanitation was a part of that course, and I had the opportunity to travel with milk sanitarians as they visited dairy farms. We followed the milk from the cow to the barn, from the storage tank to the truck, and then to the processor. At the processor, it was filtered, pasteurized, and processed into the milk for my cereal and the ice cream for my dessert. I learned about the federal Pasteurized Milk Ordinance (PMO) and all of the illnesses that used to be associated with the consumption of raw milk.

Therefore, it was a surprise to learn recently that a legislator in my home state of North Carolina had introduced a bill in the General Assembly which would allow individuals to purchase raw milk directly from a producer through an arrangement known as "cow share." This bill would allow an individual to purchase a portion of the raw milk produced by a dairy cow. North Carolina environmental health officials at the state level requested that NEHA support them in their opposition to this bill. In discussing this matter at the NEHA board meeting just prior to the AEC in Atlantic City, it became apparent that similar legislation was being introduced in state legislatures across the country. In North Carolina's case, an individual who was an advocate of natural food was able to convince a legislator to introduce the "Cow Share Bill." North Carolina health officials were united in their opposition to this bill, especially in light of a Listeria outbreak in 2002 caused by soft Mexican-style cheese made from raw milk. The outbreak resulted in several pregnant women having spontaneous abortions, as well as the hospitalization of several women and infants. The board passed a motion directing NEHA President Rick Collins to write a letter opposing the "cow share" proposal. A committee was formed to draft a position paper regarding the sale and distribution of raw milk.

As a part of that committee, I had an opportunity to research the history of pasteurization laws in the United States. I was surprised to find that commercial milk pasteurization equipment was available in the late 1800s, but it would be decades before pasteurizations were required. 1 found a newspaper article in a 1906 Chicago Tribune describing a board of health proposal to require pasteurization of milk as a way to decrease the number of deaths of children due to milk from cows infected with diseases such as tuberculosis. Chicago has the distinction of being the first city in the United States to mandate the pasteurization of milk. New York and other major cities followed suit shortly after that. The introduction of the Grade "A" Pasteurized Milk Ordinance states that in 1938, milkborne outbreaks constituted 25 percent of all disease outbreaks due to infected food or contaminated water. The CDC publication Morbidity and Mortality Weekly Report (MMWR) reveals that a number of recent raw milkborne outbreaks have occurred. These include Salmonella typhimurium in Pennsylvania in 2007, and other outbreaks in Ohio, Illinois, Indiana, Tennessee, Wisconsin, North Carolina, and Massachusetts.

Using an Internet search engine such as Google or Yahoo is certainly a quick way to find information. I expected to find factual information from the Food and Drug Administration, CDC, and major universities regarding milkborne disease. I was not prepared to see the number of hits on sites that advocate the consumption of raw milk. Some of these sites attribute to raw milk amazing properties, including curing disease and eliminating food allergies. Raw milk is touted as nature's most perfect food. More than one of these sites suggest that recent milkborne disease is a result of pasteurization.

NEHA has now officially adopted a position paper on the sale and distribution of raw milk. The paper is a collaboration of members of the NEHA board, along with valuable suggestions and input from individuals with extensive training and experience in food-borne disease. The paper is available on the NEHA website, www.neha.org. NEHA has now joined the growing number of environmental health, public health, and industry groups that have adopted position papers about the dangers of raw milk.

The PMO gives federal jurisdiction in the case of interstate movement of milk. Individual states regulate milk within their borders. Environmental and public health professionals need to be prepared to defend the public's right to be protected from products that are intrinsically dangerous, such as raw milk. We should strive to be like those tribal elders who heeded the lessons of their predecessors and be ready to lead our citizens to safety. If we stand silent, it will just be deja vu all over again.

Corresponding author: Thomas R. Ward, Public Health Preparedness Coordinator, Union County Health Department, 1224 W. Roosevelt Boulevard, Monroe, NC 28110. E-mail: [e-mail]. Region 7 Vice President for NEHA members in the states of Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee.

Thomas R. Ward, R.E.H.S., R.S., A.B., M.P.A.

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