Clinton Ray Miller has been drinking "raw" milk for the past 40 years. Though sales of unpateurized, raw milk are illegal in Virginia, Maryland and the District of Columbia, the Alexandria resident says he has always been able to purchase it "underground" at a nearby dairy.
Miller is a lobbyist for the National Health Federation, a 30-year-old nonprofit organization dedicated to preserving the "health freedom" of Americans. Despite the substantial health risks that medical experts claim are linked to unpasteurized milk, Miller says he wants the right to make his own decision on whether to continue drinking it.
However, public health officials in the federal government and organizations such as the American Academy of Pediatrics and the American Veterinary Medical Association believe raw milk poses too great a danger to the public to remain on the market. Last fall Public Citizen's Health Research Group, a consumer lobby founded by Ralph Nader, and the American Public Health Association sued the Department of Health and Human Services (HHS) to force the agency to ban all sales of raw milk products, including those that do not cross state lines. At least 20 states still allow the commercial sale of raw milk.
In their complaint, the groups alleged that consumption of unpasteurized milk poses a serious health hazard, saying that since 1980 "there have been over 600 reported cases of bacterial disease caused by the use of raw milk."
The two groups also told the court that a delay by HHS in issuing a ban was "due entirely to political pressure imposed on the agency by raw milk producers and their representatives." The U.S. District Court for the District of Columbia on Jan. 14 called the Department's justification for its continued delay "lame at best and irresponsible at worst," and ordered HHS to publish a proposal within 60 days.
Ten years ago, the Food and Drug Administration decided to require that all milk be pasteurized, but the regulation was put on hold after raw-milk producers filed objections. In April 1983, FDA drafted another proposal to ban interstate sales of raw milk and forwarded it to its parent agency, the Department of Health and Human Services, for approval. The proposal was shelved by Robert Rubin, former HHS assistant secretary for planning and evaluation. Then, in 1984, the Health Research Group petitioned HHS to require pasteurization, charging that the administration "denied the well-established scientific basis for this ban" by "yielding to political pressure" from "the U.S. raw milk capital, Southern California, home of Alta Dena Dairy, the major U.S. raw milk producer."
Alta Dena Dairy, located in Los Angeles County, and Mathis Dairy, in Decatur, Ga., are the only two "certified raw milk" dairies in the country. According to Raymond Novell, attorney for Alta Dena, the dairy produces 10,000 to 15,000 gallons of raw milk per day -- about 20 percent of its entire milk production (the rest is pasteurized). "Certified" means that the dairies follow certain standards set up by an industry association to assure clean, hygienic practices. Novell says Alta Dena takes daily samples of its raw milk to determine bacterial counts and tests its employes to make sure they are carrying no diseases.
Yet, according to Irving Bell of the Kentucky department of health, who represented a group of state food and drug regulatory officials at an FDA hearing on the raw milk issue last fall, only pasteurization can provide the "extra measure of safety that is needed."
Novell acknowledges that California health officials have ordered recalls of Alta Dena milk many times in the past few years because they found salmonella, a food poisoning microorganism, in the milk. But, he adds, "isolation" of one salmonella organism "isn't an illness."
Salmonella is one of the organisms sometimes isolated in raw milk that has public health officials worried. A common microorganism that is often found in raw meat, poultry and eggs, it is destroyed by heat and by pasteurization. Raw milk producers say because the microorganism is found in other food products, raw milk is being unfairly singled out. However, counter those urging a ban, meat and poultry are cooked before consumption; raw milk is not.
According to Morris Potter, a veterinary epidemiologist with the Centers for Disease Control in Atlanta, between 1965 and 1983, 11 outbreaks of salmonellosis associated with the drinking of unpasteurized milk, involving more than 300 persons, were reported to the CDC. But what concerns Potter and other public health officials the most is an especially virulent strain of salmonella, called salmonella dublin, reported to be on the increase in California in the last few years. Salmonella dublin is often harbored by cattle and can "shed" into the milk. Those most vulnerable to the organism are the very young and old, and those with chronic diseases.
While most cases of the common strains of salmonella do not require hospitalization, the hospitalization rate for those infected with salmonella dublin is 80 percent and the death rate is 25 percent, according to Dr. John Bolton, a pediatrician from San Francisco and assistant clinical professor in pediatrics at the University of California Medical Center. Bolton noted at the hearing that certified raw milk is advertised as a pure, wholesome, healthful food, and a "basic food for invalids."
One outbreak involving raw milk consumption in a northern Minnesota community last year has health officials stumped, because they have so far been unable to discover the infectious agent causing it. Michael Osterholm, chief of the acute disease epidemiology section of the Minnesota department of health, said that 122 people in Brainerd, Minn., were identified with symptoms of chronic, unremitting diarrhea. All had consumed milk from one local dairy, and no new cases appeared after the dairy shut down. As of last September, only 22 of the 122 people had fully recovered; many of the people had first experienced the symptoms months before. Osterholm says a national search continues for similar cases, adding that it seems to be "increasingly apparent that these are widespread and occurring with some frequency."
Raw milk bans have been effective, according to epidemiologists. Between 1980 and 1984, according to Potter, 94 percent of the salmonella dublin isolations were made by health department officials in states that still permit the commercial sale of unpasteurized milk. A nationwide ban imposed in Scotland in 1983 lowered drastically the number of persons who suffered from milk-borne salmonella infections.
Experts also say that raw milk consumption is responsible for outbreaks of another intestinal disease, camplyobacteriosis. Other diseases associated with drinking raw milk include brucellosis, Q fever, tuberculosis, staphylococcosis, streptobacillosis, and toxoplasmosis. Says Sidney Wolfe of the Health Research Group about consumers of raw milk: "They think it's more beneficial than it really is and they think it's less dangerous than it really is."
But advocates of raw milk consider it something of a miracle food. They say pasteurization can destroy the nutritional value of milk and make some nutrients, like calcium, more difficult for the body to absorb. According to Potter, however, pasteurization causes "insignificant decreases" in thiamine, vitamin B12 and vitamin C content. Writing in the Journal of the American Medical Association, Potter says nutrition studies have shown no advantage of raw over pasteurized milk. At the hearing, several pro-raw milk witnesses noted that many dairies, during the pasteurization process, heat the milk for too long a time and at temperatures that are too high, destroying more nutrients than some studies show.
Another purported benefit of raw milk is that it contains beneficial enzymes, hormones and antibodies not found in pasteurized milk. Dr. John Douglass, an internist at Kaiser Permanente in Southern California, testifying at the FDA hearing, said raw milk may provide immunological benefits. One study touted by raw milk supporters suggests that as an alternative to mother's milk, oral administration of cow milk antibodies may provide immunity against pathogens in an infant's gut. Says Novell: "In reviewing the literature, it becomes obvious that very few, if any, studies until recently have been performed on bovine or cows' milk to determine if it is more valuable in its natural state, that is, unpasteurized."
Other benefits of certified raw milk, according to Douglass: fewer reports of allergic reactions and lactose intolerance. He suggests raw milk be labeled with its "pros and cons" so that consumers can weigh the risks and benefits for themselves. Some local jurisdictions, such as San Francisco, have required labels on raw milk warning of its risks, based on the assumption that most consumers are unaware of them.
Like most public health issues involving the government, politics has played as large a role as science in the raw milk issue. Wolfe charges that Alta Dena Dairy found a "sympathetic ear" in HHS through its former general counsel, now a congressman, Rep. William Dannemeyer (R-Calif.). In May 1983, Dannemeyer and 35 other congressmen wrote to HHS protesting the ban. The letter said the benefits of raw milk included the reduced risk of arteriosclerosis allegedly caused by using pasteurized and homogenized milk. The theory is based on the writings of a Boston physician who claims that the homogenization process changes the fat globules in milk, allowing them to build up in the interior of arteries. Wolfe called the alleged benefit "unsubstantiated."
Also cited by Wolfe as evidence of political pressure is a March 1983 internal memo from an HHS researcher to Dr. Edward Brandt, former HHS assistant secretary of health, that called Rubin, then assistant secretary, the "stumbling block" to the approval of the regulation, and said that "moving this issue off dead center involves more than the science of the issue."
Responding to charges of political pressure, Novell asks, "If we had enough political pressure, why would we have this problem?" Alta Dena, however, has not sat still. Last year, it hired two biostatisticians to review several studies by California health department officials linking the cases of illness with raw milk consumption. The biostatisticians criticized the studies for a lack of controls. Novell denies Wolfe's charge that 16 deaths in California have been associated with the ingestion of Alta Dena raw milk since 1980, claiming, "Nobody in 30 years has died from consuming Alta Dena milk."
FDA's Center for Food Safety and Applied Nutrition is currently drawing up recommendations to the FDA commissioner on whether to propose a regulation banning raw milk, based on the testimony and studies presented at the hearing last fall. Yet even a nationwide ban is unlikely to deter passionate believers in raw milk, who will probably always be able to take a pail to a nearby dairy and get it filled -- fresh from the cow.