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SPECIAL EDITION V:Salmonella/Tomato Crisis Continues For Most Of Mexico

Let’s Be Frank About
Risks Associated With Fresh Produce

Jim Prevor’s Perishable Pundit, June 17, 2008

During the spinach crisis of 2006, we ran a piece entitled A Look At The Faces that included photographs of those who had died as a result of the outbreak. We ran it because, in considering what actions to take, it was simply essential that the industry remember we were dealing with real people.

This time, fortunately, there have been no deaths officially attributed to the outbreak but a 67-year-old man named Paul Rivera, under treatment for cancer in Houston, died after he was hospitalized due to nausea, diarrhea and high fever.

Although his death certificate officially attributes his death to lymphoma, the cancer of the lymphatic system that Mr. Rivera was suffering from, the city health department was quoted in the Houston Chronicle, pointing this out:

“…salmonella poisoning, extremely dangerous for infants, the elderly and cancer patients and others with a depressed immune system, was a contributing factor.”

And the CDC puts it this way:

No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.

Mr. Rivera’s wife explained what happened this way:

Barbara Rivera said her husband joined family members in a celebratory meal at a local Mexican restaurant in late May after he was told there was new hope he would survive his cancer. Rivera had already undergone eight chemotherapy and 14 radiation treatments and most of his tumors had shrunk.

Rivera’s wife said her husband and four other family members ate pico de gallo, a tomato-based condiment. Two days later Rivera began suffering nausea and diarrhea. For several days he was treated at home with pain relievers and liquids. He was admitted to a hospital six days after the meal.

Rivera died Wednesday. The four others also became ill, Barbara Rivera said, but didn’t require hospitalization.

Of course, our hearts and those of all in the industry go out to Mrs. Rivera and her family. We wish them peace and pray that they should be blessed with joyful memories of the departed.

Yet there is, in this sad loss, a story for the produce industry that may well test our intentions to do no harm.

At a dinner for five people, everyone became ill, we are told, but four were not ill enough to go to the hospital. The one with the impaired immune system was hospitalized and eventually died.

Now we have a back story here. The Pundit Poppa was a leukemia patient at M.D. Anderson in Houston, Texas. This is the premier cancer hospital in Houston and one of the premier cancer hospitals in the world.

During our stay in Houston, the Pundit Poppa was given a stem cell transplant from his identical twin brother. As part of the process, they gave heavy doses of chemotherapy to destroy the immune system. After the transplant the immune system gradually rebuilds.

Every case and treatment is different, and we certainly aren’t in any position to judge Mr. Rivera or the advice given him by his doctors. But the notion of a patient with a compromised immune system — who had undergone 14 radiation and eight chemotherapy treatments — being out at a Mexican restaurant eating fresh fruits and vegetables is very alien from the advice our doctors at M.D. Anderson gave to us.

In the hospital itself, the floor we were on allowed no fresh fruits, vegetables or flowers at all — they could carry dangerous pathogens.

Before we were released, we were cautioned to maintain that ritual — no fresh fruits, vegetables or flowers for many months. We were also advised against going to restaurants for some time. The Pundit vividly remembers being scared half to death by the doctor telling us the story of a vibrant 23-year-old patient who after the transplant was feeling great and forgot or didn’t believe that he had a compromised immune system. He went out partying with his friends one night, caught a bug his system couldn’t shake off and died.

Momma Pundit hadn’t really cooked in a long time, but she went back to cooking every meal for months. When we finally decided after many months of good health to try a restaurant, the Pundit brother made sure we would have a whole section to ourselves, and we went at an odd time such as 3:00 PM so nobody would be there anyway — and the Pundit Poppa still wasn’t allowed to order anything raw.

Here at the Pundit, we get lots of phone calls from people who want to know what produce to feed their spouse, child, parent or friend who has cancer — and we always refer them to their doctor with a warning to ask about the possibility of acompromised immune system and whether they should only be eating cooked fruits and vegetables. In fact sometimes they have to be purchased cooked, as canned produce typically is, rather than risk undercooking or bring into the house pathogens.

We think this is all important because it speaks to how we should be marketing fresh produce. We emphasize the healthful nature of fresh produce, focus on increasing consumption but, perhaps, we have an obligation to be more frank.

Fresh produce is enormously safe — for almost everyone. But people with impaired immune systems run special risks. The CDC, following its usual pattern of telling the public everything except for useful information, has pointed out that in this Salmonella Saintpaul situation the sick people range in age from less than a year old to 88 years old.

CDC won’t tell us the precise age and medical condition of each person who has been sickened in the outbreak — particularly those who have been sickened severely enough to be hospitalized.

This information is crucial because it can help define what the problem and thus what the solution is.

In the spinach crisis, everyone who died was either a child or elderly. This man whose death has been quasi connected to the Salmonella Saintpaul outbreak was a cancer patient with an impaired immune system.

There is no question that the industry will continuously strive to improve food safety and, certainly, marketers may tell us they want to avoid any negative talk about fresh produce. Yet, it seems like a moral obligation for the industry to speak the truth very frankly.

Fruits & Veggies — More Matters covers all forms of produce — not just fresh. We should add a box to the front page of the More Matters web site that points out the following:

There are many forms of produce — fresh, frozen, canned, dried and juice — and if you are dealing with a very young child whose immune system is not developed, an elderly person or cancer patient whose immune system may be compromised, it may be advisable to eat fruits and vegetables that have been cooked, either by the consumer or by the producer of a canned or frozen or juice item. For information on how and what to choose if you or one you care for falls into this category, click here.

This would have two good effects:

First, in the event of an outbreak, it would put the industry on record as saying that some people should not be eating the product. Thus any serious illnesses among this population — most of the hospitalizations or deaths come from the immune impaired — are identified as an illness that results from use of the product in a way not intended by its producer.

Second, it would be true and genuinely helpful. It would mean the industry is being straight with it customers and itself.

Maybe it would switch some business from fresh to canned or frozen. If so, that amount of business is likely to be less than is lost from outbreaks getting people hospitalized and, sometimes, worse.

We don’t need to get moms to put fresh spinach in smoothies for three-year-olds — let them buy frozen. We don’t need cancer patients putting their lives at risk to eat fresh salsa — the jarred stuff is not bad.

We want to sell healthy, wholesome food to people who can enjoy it and grow strong with it. We should tell people that.

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