[Paleopsych] NYT: Op-Ed: Got Toxic Milk?

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Got Toxic Milk?
New York Times Op-Ed, 5.5.30
http://www.nytimes.com/2005/05/30/opinion/30wein.html

    By LAWRENCE M. WEIN

    Stanford, Calif.

    WHILE the anthrax scare at Washington post offices this year proved to
    be a false alarm, it was a reminder of how vulnerable Americans are to
    biological terrorism. In general, two threats are viewed as the most
    dangerous: anthrax, which is as durable as it is deadly, and smallpox,
    which is transmitted very easily and kills 30 percent of its victims.

    But there is a third possibility that, while it seems far more
    mundane, could be just as deadly: terrorists spreading a toxin that
    causes botulism throughout the nation's milk supply.

    Why milk? In addition to its symbolic value as a target - a glass of
    milk is an icon of purity and healthfulness - Americans drink more
    than 6 billion gallons of it a year. And because it is stored in large
    quantities at centralized processing plants and then shipped across
    country for rapid consumption, it is a uniquely valuable medium for a
    bioterrorist.

    For the last year, a graduate student, Yifan Liu, and I have been
    studying how such an attack might play out, and here is the situation
    we consider most likely: a terrorist, using a 28-page manual called
    "Preparation of Botulism Toxin" that has been published on several
    jihadist Web sites and buying toxin from an overseas black-market
    laboratory, fills a one-gallon jug with a sludgy substance containing
    a few grams of botulin. He then sneaks onto a dairy farm and pours its
    contents into an unlocked milk tank, or he dumps it into the tank on a
    milk truck while the driver is eating breakfast at a truck stop.

    This tainted milk is eventually piped into a raw-milk silo at a
    dairy-processing factory, where it is thoroughly mixed with other
    milk. Because milk continually flows in and out of silos,
    approximately 100,000 gallons of contaminated milk go through the silo
    before it is emptied and cleaned (the factories are required to do
    this only every 72 hours). While the majority of the toxin is rendered
    harmless by heat pasteurization, some will survive. These 100,000
    gallons of milk are put in cartons and trucked to distributors and
    retailers, and they eventually wind up in refrigerators across the
    country, where they are consumed by hundreds of thousands of
    unsuspecting people.

    It might seem hard to believe that just a few grams of toxin, much of
    it inactivated by pasteurization, could harm so many people. But that,
    in the eye of the terrorists, is the beauty of botulism: just one
    one-millionth of a gram may be enough to poison and eventually kill an
    adult. It is likely that more than half the people who drink the
    contaminated milk would succumb.

    The other worrisome factor is that it takes a while for botulism to
    take effect: usually there are no symptoms for 48 hours. So, based on
    studies of consumption, even if such an attack were promptly detected
    and the government warned us to stop drinking milk within 24 hours of
    the first reports of poisonings, it is likely that a third of the
    tainted milk would have been consumed. Worse, children would be hit
    hardest: they drink significantly more milk on average than adults,
    less of the toxin would be needed to poison them and they drink milk
    sooner after its release from dairy processors because it is shipped
    directly to schools.

    And what will happen to the victims? First they will experience
    gastrointestinal pain, which is followed by neurological symptoms.
    They will have difficulty seeing, speaking and walking as paralysis
    sets in. Most of those who reach a hospital and get antitoxins and
    ventilators to aid breathing would recover, albeit after months of
    intensive and expensive treatment. But our hospitals simply don't have
    enough antitoxins and ventilators to deal with such a widespread
    attack, and it seems likely that up to half of those poisoned would
    die.

    As scary as this possibility is, we have actually been conservative in
    some of our assumptions. The concentration of toxin in the terrorists'
    initial gallon is based on 1980's technology and it's possible they
    could mix up a more potent brew; there are silos up to four times as
    large as the one we based our model on, and some feed into several
    different processing lines that would contaminate more milk; and the
    assumption that the nationwide alarm could go out within 24 hours of
    the first reported symptoms is very optimistic (two major salmonella
    outbreaks in the dairy industry, in 1985 and 1994, went undetected for
    weeks and sickened 200,000 people).

    What can we do to avoid such a horror? First, we must invest in
    prevention. The Food and Drug Administration has some guidelines -
    tanks and trucks holding milk are supposed to have locks, two people
    are supposed to be present when milk is transferred - but they are
    voluntary. Let's face it: in the hands of a terrorist, a dairy is just
    as dangerous as a chemical factory or nuclear plant, and voluntary
    guidelines are not commensurate with the severity of the threat. We
    need strict laws - or at least more stringent rules similar to those
    set by the International Organization for Standardization in Geneva
    and used in many countries - to ensure that our milk supply is
    vigilantly guarded, from cow to consumer.

    Second, the dairy industry should improve pasteurization so that it is
    far more potent at eliminating toxins. Finally, and most important,
    tanks should be tested for toxins as milk trucks line up to unload
    into the silo. The trucks have to stop to be tested for antibiotic
    residue at this point anyway, and there is a test that can detect all
    four types of toxin associated with human botulism that takes less
    than 15 minutes. Yes, to perform the test four times, once for each
    toxin, on each truck would cost several cents per gallon. But in the
    end it comes down to a simple question: isn't the elimination of this
    terrifying threat worth a 1 percent increase in the cost of a carton
    of milk?

    One other concern: although milk may be the obvious target, it is by
    no means the only food product capable of generating tens of thousands
    of deaths. The government needs to persuade other food-processing
    industries - soft drinks, fruit juices, vegetable juices,
    processed-tomato products - to study the potential impact of a
    deliberate botulin release in their supply chains and take steps to
    prevent and mitigate such an event.

    Americans are blessed with perhaps the most efficient food
    distribution network in history, but we must ensure that the system
    that makes it so easy to cook a good dinner doesn't also make it easy
    for terrorists to kill us in our homes.

    Lawrence M. Wein is a professor of management science at Stanford
    Business School.