Food safety and the media: the case of Vibrio vulnificus.
Through NEHA's long-standing and excellent relationship with NSF International, NEHA was granted permission by NSF International to share with the Journal's readership various papers that were presented November 16-18, 1998, at the "First NSF International Conference on Food Safety" in Albuquerque, New Mexico. This paper, "Food Safety and the Media: The Case of Vibrio vulnificus," is one of them.
It is important to note that these papers were screened by an NSF International/Conference for Food Protection advisory committee prior to their presentation at the conference, but they have not been peer reviewed by NEHA's Journal program for technical accuracy.
Because these papers contain useful and interesting ideas and information that may be either delayed or lost if sent through the Journal's normal peer review process, NEHA has decided to publish them as presented, with only minor editorial modifications.
We hope you look forward to more of these papers in future issues of the Journal!
Through an examination of a report on one emerging foodborne disease and its perceived effects in New York City restaurants, this case study explores the role the print media has played in the developing story of food safety hazards. There is no doubt that John Q. Public receives most of his science information from the media (Nelkin, 1987). The media helps to interpret risk for the public. Although three kinds of public can be distinguished - the passive public, the attentive public, and the active public (U.S. National Research Council, 1989) - for the purposes of this study, the three publics are considered one. The media have a dual and apparently conflicting role: They both reflect public opinion and, at the same time, tell the public what to think. Kone and Mullet (1994) have reported that the way the media depict an issue has a serious effect on consumer opinions and behavior.
By making a series of choices about topic and presentation, journalists equip readers to think about scientific issues in specific ways. In 1993, the Scientists' Institute for Public Information confirmed that a substantial number of American adults want serious scientific news, particularly in the area of personal health. An interest in health issues leads the way for interest in science news. Chew et al. (1995) found that health-related topics represented at least a quarter of all daily newspaper articles. Reports about issues of food safety and health have left the science pages and have become front-page news. Many are calling food safety the "fat" story of the late 1990s, alluding to the extensive coverage the fat content of the American diet received in the food/science press during the late 1980s and early 1990s. During the first six months of 1998, the New York Times and the Daily News ran a number of front-page stories about food safety One of the Times stories, titled "For Oystermen a Harvest of Risk and Burden" (St. George, 1998), formed the basis for this case study The story detailed the emergence of Vibrio vulnificus in Gulf oysters over the last two decades and its potential lethal consequences for a small portion of the population. According to the author, "millions of people eat Gulf oysters with no ill effect and here, as in many other industries, health officials are grappling with a kind of moral arithmetic of regulation, weighing lives potentially lost, workers displaced and traditions ended" (p. 1). This study explores the manner in which that "moral arithmetic" added up among the print media, restaurants, and their customers.
Vibrio vulnificus, a bacterium in the same family as cholera but originating in warm sea water, causes disease when people eat contaminated seafood (particularly raw oysters). Among healthy people, it normally causes vomiting, diarrhea, and abdominal pain; but among immunocompromised persons, particularly those with chronic liver disease, V. vulnificus can infect the bloodstream, causing septic shock that is fatal in about 50 percent of the cases. The incidence of illness, however, is very low in the overall population. The Centers for Disease Control and Prevention (CDC) received only 167 reports of Vibrio vulnificus infections between 1989 and 1997; 87 of the cases were fatal. The Gulf Coast states of Alabama, Florida, Louisiana, Texas, and Mississippi, which harvest almost 60 percent of the nation's oyster crop, report the majority of cases.
The "For Oystermen ..." story in the New York Times provided the catalyst for this study of the media's role in food safety and of its perceived effects on sales in seafood restaurants in New York City. The author was struck by the fact that a noteworthy paper would feature a front-page, above-the-fold article on a foodborne pathogen that had been confined primarily to another geographical area and that had been responsible for perhaps only two fatalities in the greater New York metropolitan area in the past few years. Could this one story affect sales of a trendy menu item in high-end restaurants?
Fifty billion meals are eaten in restaurants, schools, and cafeterias each year, and almost half of all adults were restaurant patrons on a typical day during 1995 (National Restaurant Association, 1997). Customers rely on restaurants to provide them with wholesome food and to be the experts on food safety (Featsent, 1998).
For many Americans, especially those who live near the coastlines, "eating oysters on a regular basis is more than a ritual - it is a way of life" (Kay and Kay, 1996, p. 185). Oyster bars and seafood restaurants at which raw oysters are a specialty are popular. Establishments range from grand restaurants to down-home shacks. For this study, 80 seafood restaurants identified in the 1998 Zagat Survey of New York City Restaurants (1997) were surveyed with a questionnaire. Follow-up interviews were conducted with several of the respondents.
The intention was to explore, with surveys and interviews, the extent to which print media reports about a foodborne pathogen were perceived to affect sales of raw oysters in New York City restaurants. Quantitative and qualitative methodologies were combined to provide an in-depth view of this complex and previously unexplored issue. The survey results provided a description of the general behavior of seafood restaurants; the interviews allowed the researcher to seek answers to the questions how and why from the point of view of the individual restaurateurs. The qualitative interview provided an effective way to examine the complicated relationships among the print media, issues of wholesomeness, and commercial enterprise.
The author designed a questionnaire that was partially based on a survey used by Boo et al. (1998), which studied consumers' perceptions and concerns about the safety and healthfulness of food served at outdoor fairs and festivals, and partially based on a survey reported in Restaurant Business (Breuhaus, 1998), which examined food safety hazards, concerns of restaurant operators, and concerns of customers. The questionnaire developed for this study contained four sections: demographics, customer perceptions and concerns about food safety in general, a ranking of persons or organizations responsible for the safety and wholesomeness of seafood in restaurants, and the role played by the print media as indicated by reporting on food safety or seafood and by customer response (identified as a decrease in sales). A cover letter, the questionnaire, and a self-addressed stamped envelope were mailed to the Zagat-identified restaurants. Seventeen out of 80 questionnaires (21 percent) were returned with all the questions answered. The survey was followed by five in-depth interviews conducted with executive chefs or general managers of New York City seafood restaurants.
Collecting and Recording of Data
Once the surveys had been returned and an initial analysis of that data was complete, the author prepared a list of 10 possible sites for interviews. The goal was to interview a broad range of New York City restaurants, the only criteria being that they offered raw oysters on a daily basis. Restaurants where interviews were conducted included an historical raw bar/cafe, a quintessential New York raw bar, an Upper East Side neighborhood seafood restaurant, a landmark seaport/tourist restaurant, and a Greenwich Village seafood luncheonette. Seafood restaurants in New York City are expensive, especially if they include a raw bar. Four out of five of the restaurants where interviews were conducted reported average dinner checks of $35 or more; the average check at the luncheonette restaurant was $25. The author guaranteed complete confidentiality to each interviewee and, when possible, anonymity.
All subjects were interviewed in their restaurants according to the same interview protocol. The interviews were recorded and transcribed in their entirety. A log was maintained that contained the word-processed interviews and analysis. This log became one portion of the study database. Two basic kinds of notes formed the interview log and were used to facilitate analysis: descriptive notes of the interview and theoretical notes that formed the analytical speculations. Relevant data were noted and analyzed. Categories were visualized in chart form, and data were listed under categories. Patterns emerged from these analyses and are indicated in the results section of this paper. The interview logs and the results from the questionnaire were eventually subjected to cross-case analysis.
Table 1 summarizes the demographic data obtained from the restaurant questionnaires. The majority of respondent restaurants were classified as moderately expensive or expensive restaurants with average dinner checks (including tax and wine) of $23 and $40 respectively. Almost 90 percent of the restaurants reported that seafood accounted for at least half of their menu items. More than 75 percent of the restaurants devoted at least a quarter of the menu to raw seafood items.
The restaurants were asked to identify the person or organizations they believed to be responsible for the safety and wholesomeness of the fish or seafood items served in their restaurants. Rankings in descending order of responsibility were as follows: chef, manager, purveyor, owner, New York City health inspector, New York State Health Department, federal health agencies.
TABLE 1 Demographic Characteristics of New York City Seafood Restaurants Demographic Descriptor Number of Restaurants Average dinner check N = 17 below $15 0 $16-$30 7 $31-$50 9 $51+ 1 Percentage seafood items on menu N = 17 below 25% 0 26-50% 2 51-75% 8 76-100% 7 Percentage raw seafood items on menu N = 17 below 25% 13 26-50% 4 51-75% 0 76-100% 0
Table 2 shows the results from questions that asked the restaurants to rank their perceptions of customer concern about food safety in restaurants generally and in their restaurant specifically. The majority of restaurateurs indicated that their customers were concerned or very concerned about the wholesomeness of seafood in general; but when participants were asked if this concern carried over to their own establishments, the numbers almost reversed, with the majority indicating little or no concern about their restaurants. This finding was corroborated in interviews and may be interpreted as confirmation that customers choose seafood restaurants on the basis of reputation and high turnover. Customers choose restaurants whose management they believe to be committed to providing wholesome products.
The questionnaire asked the restaurateurs to rank the extent to which sales were negatively affected by print media articles about general food safety and sanitation issues in restaurants, as well as the extent to which sales were affected by articles that dealt specifically [TABULAR DATA FOR TABLE 2 OMITTED] with the safety of raw seafood. Table 3 shows results from this question. Over 80 percent of restaurateurs felt that print media articles on food safety had little or no effect on their sales. This finding was the most surprising result from the questionnaire. The research design allowed for further examination of this finding through in-depth interviews with respondents.
In response to the original research question about the effect of the February 1998 New York Times article on Vibrio vulnificus, the respondents reported little or no loss of business.
Because of the time constraints of chefs and managers, the interviews were designed to be completed in 20 to 30 minutes. The researcher used a funnel approach: Interviews began with general and descriptive questions to clarify results from the questionnaire. Then subjects were probed for explanations of their perceptions of the role played by the print media relative to their restaurant and their customers. Chefs and managers were also asked to identify those associations or organizations they turn to for clarification of and information about food safety issues and foodborne hazards in seafood. To conclude, interviews asked for suggestions for improving the wholesomeness of raw seafood in restaurants.
The chef and managers who were interviewed agreed with the survey respondents in identifying the chef as the person primarily responsible for the wholesomeness of seafood products. They did, however, stress that this responsibility was shared with the seafood purveyor or source. The relationships among purveyors, distributors, oyster farmers, and chefs was identified as critical to delivering safe seafood, particularly oysters. The relationship is complex and was described as based on trust but also adversarial.
Every chef or manager had been certified by the New York City Department of Health. The interviewees affirmed the effectiveness and importance of this course in their ongoing food safety and sanitation education. For information on current issues in food safety, they looked to the restaurant and seafood trade presses. Four out of five reported using the Internet and food safety web sites to research seafood safety questions but none of the restaurants provided on-line computers for the chefs or managers. The interviewees did this research on their own time on their home computers.
All chefs and managers were concerned about costs, but when they were making decisions about raw oysters, quality and wholesomeness were of foremost concern. The owner/general manager of the seaport/tourist restaurant described the purchasing process in the following manner:
The most crucial part of purchasing is knowing what to look for ... just put things in the old Bell curve from Statistics 101.1 tell my purveyors I only want to buy from the 99th percentile or better. And because I go to the Fulton Fish Market every day, see these guys every day, and buy in small quantities, it's possible for me to get just that.
The reason survey respondents reported that the article on Vibrio vulnificus had no negative [TABULAR DATA FOR TABLE 3 OMITTED] effect on sales was easily discernible in the interviews; none of the interviewees bought oysters from the Gulf Coast. The chef from the quintessential raw bar (which sells over 1.5 million pieces of raw oyster a year) described how and why he buys oysters from certain beds and not from others:
There are lots of variables when you are buying oysters, especially since they are a living organism. They can be dry, smell, have an off color, a milky belly, be spawning. These are all signs of problems. First of all, we only buy oysters from north of the Mason-Dixon line. We don't buy southern oysters, and we don't buy any oysters from the Gulf. Gulf oysters have a very high chance of Vibrio. We won't sell them. I have been here for 10 years, and we have never sold a Gulf oyster.
The chef/owner of the Greenwich Village luncheonette concurred:
I won't eat Gulf oysters, and I never serve Gulf oysters. There was that incident last year at XXX, where the guy died from that flesh-eating disease and raw Gulf oysters were the cause. It's just crazy to serve Gulf oysters to save a quarter, it's just not worth it.
No chef or manager interviewed for this study bought Gulf oysters; none had bought them for the past decade. In other words, restaurateurs were ahead of the consumer print media. From the trade press, industry association newsletters, and food safety web sites, the restaurateurs had learned of the possibility that Gulf Coast oysters would be contaminated with Vibrio vulnificus. There was consensus that when it came to the wholesomeness of raw oysters, it never paid to take a risk.
The chefs and managers have a complicated relationship with the local print media. Since chefs have become celebrities, they are courted and they court the local food press (Schrambling, 1996; Settle, 1996). Yet they are very wary of reports on food safety hazards reported in those same papers. Subjects interviewed for this study believed that local print media are in business to sell papers and that sometimes, to do so, they sensationalize food safety issues. The owner/manager at the seaport/tourist restaurant believed that
The media have their agenda, which is to sell newspapers. Unfortunately the readers don't get to the who, what, where, why, and when of the information, which is what it should be. Instead they try to scare them with the sensational. Headlines like "Waiter There's a Rat in My Soup" grab the readers. Of course, there was no rat in the soup, but you know all that guy is going to remember is that headline!
According to the chef at the historical tavern/raw bar,
Seafood is highly perishable. People have to be careful, but the media seems to hype it up when there is a problem, big or small. The public gets numb from the scare stuff; they hear so much, they turn it off after a while. I think the educated public, our customer, knows most of it is just hype.
Although the agencies responsible for protecting the health of our citizens warn that eating raw oysters from clean waters or in reputable restaurants will not guarantee protection against a bacteria like Vibrio vulnificus, customers and restaurateurs have not accepted that reality. All the chefs and managers interviewed in this study expressed a strong belief that customers go to a seafood restaurant they trust to provide wholesome product. The manager at the quintessential raw bar said:
There was a story just a couple of weeks ago about the hotel that sold tuna with scombroid poisoning and fed it to 20 lawyers ("Group Sickened After Hotel Lunch," 1998). One of our waiters saw that and said, "well, I guess we won't be selling tuna today." But we actually sold out of tuna that day. It was as if they saw the story and thought well thank goodness I am at the XXX where I can safely order tuna. Customers love seafood. They are not going to stop eating it because of a newspaper story, but they are going to come here for it because they trust us.
The chef/owner of the luncheonette confirmed this trust in a specific restaurant to serve wholesome food: Everybody is eating fish in New York now. We only serve one kind of oyster, Blue Points from Long Island, so it is easier to keep track of them. So far I haven't gotten anything bad from my purveyor or anything dug from somewhere it shouldn't have been. We have a remarkable relationship with our customers. Normally cooks don't talk to the customer, but here we bring the food up to the counter, so we talk to them. People come here two, three times a week because they trust us to serve them the freshest, best quality raw oysters.
The manager at the Upper East Side operation verified the perception:
Eating raw oysters is risky business. It's a whole, live being, guts and all. It takes a certain kind of customer to order them to begin with - you know, the ones who are adventurous, daring. But they are only willing to risk it in certain establishments where they absolutely trust the management, like ours.
Regardless of warnings from the Food and Drug Administration (FDA), CDC, and state or local health departments, restaurateurs and their customers believe reputable operations provide protection from foodborne pathogens like Vibrio vulnificus. Restaurateurs interviewed in this exploratory case study asked the question "are Gulf Coast oysters safe?" before the media report - and answered, "no!" Although the chefs and managers were obsessive, careful buyers of raw oysters, they realized they could not guarantee safety "It is always possible," as one put it, "for something invisible to slip in and ruin you." Nevertheless, they attempted to control the risk of contamination by eliminating Gulf Coast oysters from their menus.
Customers who eat raw oysters are risk takers. At least in this group of New York City restaurants, customer appetite for raw oysters and the raw bars that serve them was not diminished by media coverage of hazards associated with eating raw seafood. Customers believed they were protected by choosing quality, reputable restaurants with high turnover. Among restaurants surveyed for this study, prominent New York Times coverage of an emerging bacterium in Gulf Coast oysters had little or no effect on sales because the restaurants had already eliminated the risk. This is good news for New York City customers and restaurateurs since it indicates that restaurant managements were assuming the role of food safety expert expected of them by the public.
The chefs and managers were in agreement that the best way to improve safety in restaurants is to make the food certification course mandatory for all kitchen workers - not just one employee per restaurant, as is currently required in New York City. They talked about the diversity of their kitchen staffs and said that even when staff are trained by restaurant management, a required food sanitation certification might be more effective. Some interviewees suggested that all accredited culinary programs make HAACP certification a prerequisite for graduation.
The print media clearly have an important role to play in reporting on food safety and sanitation in seafood and in restaurants. This case study indicates, however, that no uncritical public was waiting to be filled with material from the print media. Newspapers were not more influential than common sense. The striking finding of this study was that the professionals - the chefs, the managers, the owners - were ahead of the print media in anticipating a risk factor and eliminating it by refusing to buy Gulf Coast oysters.
(Adapted with permission from Proceedings of the First NSF International Conference on Food Safety, Albuquerque, New Mexico, November 16-18, 1998.)
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* Editor's note: Because this paper was originally published in Proceedings of the First NSF International Conference on Food Safety, the references are not consistent with the Journal of Environment Health's normal style format.
Corresponding Author: Patricia S. Bartholomew, New York City Technical College, CUNY, Brooklyn, NY.