Milk 2

In most of the First World, people have enough sense to appreciate the disease-prevention aspects of modern hygiene.  In most of the third world, parents sacrifice in ways we can’t imagine to get a hold of basic survival needs of their children, like clean water and pasteurized milk.

When I lived in Utah, I met people who actually believed that treatment of municipal water was, in fact, some sort of technique by which our government was trying to control its noncompliant population.  Before I moved to Utah, I thought this was a creative device sprung fully-formed from the creative genius of Stanley Kubrick and Peter George, who wrote Dr. Strangelove.  I thought I had been transported to a scene from this classic cold-war movie, in the early 1960’s.  Now that I think about it, there were a lot of things about Utah that made me feel that way.

I was asked to write a letter saying that there was a medical reason that a preschooler should not be compelled to drink raw milk.  And, in this case, raw cow colostrum.  Apparently, the raw milk just wasn’t raw enough.  Though I’ve been here in Berkeley for more than a decade, I had never heard of people drinking raw milk or giving it purposely to their children.  So I don’t know how relevant these two posts on the topic will be for normal people who live in normal places and make normal decisions.

A comment came to the previous post inquiring about the accusation that pasteurization kills the good bacteria along with the bad in milk, and doesn’t that leave us without an important source of crucial digestive flora?  I thought about how to answer this question, besides the obvious fact that very few kids drink raw milk, lots—thousands of times as many—kids drink pasteurized milk, and all those kids don’t have serious problems with their digestive ecosystems.  But I have another way to look at it.

It’s hard to study babies.  Most parents don’t want scientists messing around with their babies, and I’m not sure it’s ethical to be poking and hurting babies for the fulfillment of scientific curiosity.  But there’s one kind of study that usually flies through every committee and review board designed to protect patients from the voracious appetites of modern science.  The poop study.  Baby poop is plentiful, easily collected, doesn’t hurt the baby and is a more renewable resource than the greenest, fair-tradiest most organic product available.  When the supply in the lab runs low, it’s not that difficult to find more.  Just about everything about this miracle material that can be studied has been studied.

Meconium, the black tarry stuff that emerges shortly after the baby emerges, is sterile.  It’s what remains of the cells that have developed into the hoses and culverts of the baby’s digestive system.  Within 48 hours of birth, every gram of the fresh stuff (every 1/30th of an ounce) has about 1,000,000,000 bacteria.  Can you imagine how crowded it is down there after a year?  Yet, somehow, all of this population explosion happens without a drop of cow’s milk, raw or otherwise.  So how essential is it?

I was told that the good bacteria in raw milk act to fight off the bad bacteria, so pasteurization actually increases the risk of getting bad bacteria.  It was hard to understand this.  But it shows a serious weakness in critical thinking.  Let’s say that it works just like they say:  good bacteria keep the counts of disease-causing bacteria relatively low.  So how is this more effective than giving your kids the kind of milk with no bacteria?  How is hoping—assuming—that the dose of deadly infectious bacteria in the raw milk you’re serving won’t be high enough to kill your child better than giving your kid the kind of milk with no bacteria?  And what about the argument that if the cow is not a feedlot cow, and is raised in a relatively pristine environment, that raw milk can be the cleanest milk available?  A few such careful families decided to pool their resources and together buy a diary cow on a farm in Washington.  In 2005, after 4 cases of potentially lethal O157:H7 E. coli were found, an investigation found a total of 18 cases.  157 people were interviewed in the investigation, but nobody became ill who didn’t drink raw milk.  17 of the 18 affected people were either part of the cow-share or children of those families.  One child was a friend who had visited and was given raw milk.  Though the age range of those affected was 1-47 years old, the median age was 9.  All of the people hospitalized were 1-13 years old.  It’s not hard to figure out why.  Of those who drank 0-1 cup of milk a day, 4% got sick.  1-2 cups a day, 7% got sick.  Of those drinking 3 cups a day, 38% got sick.  Four people in this group got Hemolytic Uremic Syndrome, in which the kidneys shut down.  It’s not something you want your child to get.

In Pennsylvania in 2007, it was Salmonella Typhimurium from raw milk at a farm stand.  Sure, most people merely get extremely ill from it.  But the case-fatality rate (yes, that’s what it means) can be 5-10% in newborns or the elderly.

What if the raw milk is “certified?”  It was easy to find reports of infection from this unregulated definition.  In an outbreak in Germany, consumption of raw milk was the only food risk factor for children under 3.

And what about lactose intolerance?  Since both pasteurized and unpasteurized milk contains lactose, there’s no advantage there.  The enzyme needed to digest it, lactase, is more active in some people than others.  For the lactose-intolerant, who have low levels of lactase, drinking raw milk (which has just as much lactose as pasteurized milk) is not likely to be an improvement.

Giving young children raw milk is dangerous.  There are lots of websites with all kinds of testimonials to its benefits.  I looked for studies confirming some or any of the alleged benefits of drinking it, and found only reports of disease and death.

 The next time somebody suggests you give your child raw milk, ask them why, and then ask how they really know that it does what they claim. 



The magnificent photograph at top is by the late Harold Edgerton, a professor at MIT and inventor of the strobe light.  He discovered ways the world worked that we never had any idea about.

Milk

This week, once again, I have had the privilege of performing a duty only those of us working in the rarefied atmosphere of Berkeley California (and places like it) get to do.  I had to write a note to a preschool principal requesting—insisting, actually—that one of my patients be served only pasteurized milk.

Remember the wax paper containers that we had in elementary school?  It was never clear which side you should open, though it did seem that one side opened easier than the other.  Often enough, for inexplicable reasons, both sides got open and the container, now missing apparently key elements of its structural architecture, would become floppy.  Drinking from it became difficult.  I’m not, just so it’s clear, nostalgic for those little containers.

To most stories, there probably are at least two sides.  The great leaders of history weren’t always the nicest people.  Certainly, along the way, history must have gotten a few of the details wrong, with the result that some of the people we admire were probably not so admirable in real life.  Here’s the thing with really big hit movies, too.  Maybe they didn’t sound so appealing when they were first released.  Maybe you weren’t so impressed when you first saw the movie.  But when not just a few but people from all over the world are seeing the movie and loving it, again and again, it must have something appealing.  So the next time you look through a list of the top 100 movies of all time, maybe you should take a chance and rent the ones you haven’t seen.  I don’t believe that the public at large is usually right about things.  But when great works of art, great people and their discoveries, stand up to the rigorous tests of time and repeated scrutiny, there’s probably a reason.

I’m willing to cut Louis Pasteur some slack.  He’s got a really famous institute named after him, and his tomb is mighty fancy.   That’s not enough.  In the last quarter of the 19th century, New Yorker Jacob Riis wrote about baby ‘farms’ in which some poor adults would, for money, take in babies from families who couldn’t afford to care for them.  The milk they were given wasn’t good, and these caretakers would give them opium to keep them quiet until they died.  This freed up space to take in more babies.  None of this particularly attracted attention, both  because of the poverty of the families involved and the brutal routine nature of this kind of illness.  This was chronicled in How the Other Half Lives, which Riis published in 1890.  In 1891 the infant mortality rate in New York City was 240 per 1000 births.  That’s about 1 in 4.  After a lot of controversy and debate, and after a major typhus epidemic blamed on raw milk, New York started enforcing rules about pasteurization.  Within a few years, the mortality rate for infants had dropped to 71 per 1000, 1 in 14.
The bacterium E. coli is in all of us.  It’s a normal component of our digestive system.  One subspecies of E. coli that has turned to the dark side is called O157:H7.  It’s a bad thing to get, and can make people very sick.  It can kill you.

During a 20-year period, from 1982-2002, about 4% of all O157:H7 cases were from raw milk products and colostrum.   Think about that.  It’s hard to get raw milk in most places.  Much, much less than 4% of the population eats raw milk products.  That means that those who do have a very high risk, compared with the population as a whole, of getting this potentially deadly infection.  Do I need to say that children are particularly vulnerable?
The first time I saw a case of Hemolytic Uremic Syndrome [HUS] I was in training and working in a children’s hospital.  It’s not something you would have seen outside of an intensive care unit.  The 4-year old I watched over was on dialysis and waiting for a kidney transplant.  She got O157:H7, was sick for no more than a couple of days before her kidneys shut down.  Even with the dialysis, without her kidneys working her body found it hard to regulate important functions like blood pressure.  There was no happy ending.

I know this is a pretty dark way to come back to the blog after a week and a half or so.  But this isn’t about disease, infection, Louis Pasteur, poverty, or organic produce.  It’s about parenting.

I believe that every caring parent has the best interests of their child at heart.  But parenting requires the use of a brain, as well.

I asked the parents who requested the letter from me to ask the people at the school why, exactly, it was so important for every child to have raw milk.  They called me and said that they were told it was simply better for the child and that there were a lot of health benefits.  ‘Like what?’ they asked.  Better nutrition they were told.  ‘Really?  More vitamins or what?’  But that was as much as they could get.  This very superficial scratching of the surface of belief revealed a hollow center.

Ask me why your child shouldn’t have raw milk and I’ll tell you what I know, what I’ve seen with my own eyes, what I’ve read a dozen times from independent sources and studies all over the world—it can be lethal.  Now ask that nice person in the mom’s group why it’s worth risking your child’s life.  What precisely are the benefits that are so overwhelming to make up for that?