Paratuberculosis and Crohn’s Disease: Got Milk? Project Censored
Crohn’s Disease
The disease is mostly found in the United Microbial foodborne illness is the largest class Described as a human scourge,33 over a half States, United Kingdom, and Scandinavia.152 of emerging infectious diseases. In 1999, the million120 Americans suffer from this devas- And it’s on the increase. The incidence in Centers for Disease Control (CDC) released the tating, lifelong condition95 with annual US med- the United States, which has been increasing latest figures on the incidence of US food- ical costs in the billions.189 Crohn’s sufferers steadily since the 1940s—doubling, then tripling, borne illness considered by the Food and Drug experience profuse urgent diarrhea, nausea, then quadrupling89—is now approaching that Administration (FDA) to be the most complete vomiting, and fevers.78 Because of the diar- of an epidemic.67 The most rapid increase has estimate ever compiled. Seventy-six million rhea, many people are unable to leave their been seen in children. In the 1940s and early Americans every year get food poisoning, more houses; others drive around in recreational 1950s there were no recorded cases of Crohn’s than double the previous estimate. In today’s vehicles or mobile homes to keep a bathroom in teenagers. Currently, one in every six new food safety lottery there’s a 1 in 4 chance you’ll close at hand.98 The director of the National get sick, a 1 in 840 chance you’ll be hospital- Association for Colitis and Crohn’s Disease says Dr. Crohn, who described one of the first series ized, and a 1 in 55,000 chance that an American the best way to describe to nonsufferers how of cases back in 1932,149 wrote decades later will die from foodborne illness annually.174 bad the disease can get is to have them think “From this small beginning, we have witnessed of the worst stomach flu they ever had and the evolution of a Frankenstein monster….”25 ness is caused by animal foods.17 The latest then try to imagine living with that every day.29 Johne’s Disease
(USDA) survey, for example, found 9 out of starts attacking the lining of the gut, which Crohn actually didn’t discover Crohn’s disease.
10 Thanksgiving turkeys contaminated with becomes swollen and inflamed.24 In extreme The first person to give it a clear description cases this painful embarrassing condition was a Scottish surgeon named Kennedy Dalziel bacterial food poisoning in the United States.175 can affect any part of the digestive system in 1913.23 He wrote, “I can only regret that the And 75% of the turkeys are contaminated with from the mouth to the anus.27 This inflam- etiology [cause] of the condition remains in two or more foodborne diseases, most often mation narrows the digestive tract and can obscurity, but I trust that before long, further Salmonella as well, which are becoming danger- result in excruciating pain during digestion consideration will clear up the difficulty.”42 ously resistant to many of our best antibiotics.55 Eighty-eight years later and the scientific soning every year in the United States, most with Crohn’s disease include severe joint Crohn’s, but Dalziel had a hunch which a grow- sufferers only experience acute self-limited pains, weight loss, and lack of energy.92 ing number of prominent scientists now think episodes. Up to 15% of those that contract The intestines characteristically become so Salmonella, however, go on to get serious deeply ulcerated that they take on a “cobble- About two decades earlier in 1895, German joint inflammation that can last for years. An stone” appearance. The ulcers can actually eat doctor H.A. Johne was the first to describe estimated 100,000 to 200,000 people suffer right through the gut wall and cause bleeding, the cause of a disease in cattle characterized from arthritis arising directly from foodborne abscesses, fistulas and perforation.150 Passing by chronic or intermittent profuse intractable infections each year in the United States.101 diarrhea.190 Clinically, the disease in cattle was The most feared complication of food poi- Crohn’s damaged intestines can be excruci- virtually identical to that which we now know soning, however, is Guillain-Barré syndrome, atingly painful. In the words of one colorectal as human Crohn’s disease.25 The gross pathol- in which infection with Campylobacter can surgeon, “Crohn’s is a surgical disease. We wait ogy of the infected cow’s intestines likewise lead to one being paralyzed for months on until the patient can no longer withstand the had the same cobblestone appearance; micro- a ventilator. Up to 3800 cases of Guillain-Barré pain anymore, and then we perform surgery scopically, the Crohn’s diseased intestines are triggered by infection with Campylobacter …and repeated surgeries over time…ultimately, and the diseased cattle intestines were dead as recurrences happen and intestinal damage ringers.23 Dalziel wrote that the tissue char- Some scientists now fear, though, that an occurs, we just cut and cut, in some cases, until acteristics were “so similar as to justify a propo- there is no more intestine that can be cut out.”24 sition that the diseases may be the same.”42 inating our food supply. Often touted as the Tragically, Crohn’s disease typically strikes He theorized that the disease in cattle and the Pulitzer Prize of alternative journalism, a Project people in their teens and early twenties— disease in people were the same entity.
Censored Award was given to what was con- destroying their health.53 Children, adolescents, sidered one of the most censored stories of and young adults suddenly become faced with Mycobacterium Paratuberculosis
1999—the connection between Crohn’s Disease the harsh reality of a lifetime of chronic pain, The cattle disease, which became known as in and out of hospitals their entire lives.27 Johne’s disease (pronounced yo-neez), is known Paratuberculosis and Crohn’s Disease: Got Milk? to be caused by a bacteria called Mycobacterium mycobacterial human diseases like a type of paratuberculosis, also known as Mycobacterium leprosy in which just a few mycobacteria are avium subspecies paratuberculosis, or MAP.183 capable of triggering a pathological immune MAP belongs to an infamous class of microbes Live Cultures
called mycobacteria which cause diseases such The next hurdle was the difficulty of consis- as tuberculosis and leprosy. In fact, before Johne tently culturing the bug from Crohn’s sufferers’ DNA Fingerprinting
properly distinguished MAP from other myco- intestines.27 Although MAP has been inde- Obtaining Crohn’s tissue samples is easy— bacteria, the disease in cattle was thought to be pendently isolated across three continents— patients are all too frequently having pieces caused by intestinal bovine tuberculosis, hence cultured from Crohn’s tissue in California, Texas, the name paratuberculosis or “tuberculosis-like.” France, Australia, England, the Netherlands, from this tissue is so difficult that a noncul- and the Czech republic27—results are still rel- ture-based method was needed. This advance of the most enigmatic bacteria known.121 It atively sparse and many labs have reported came in the late 1980s when new DNA finger- lives inside the hosts’ cells, but has no known not being able to culture it at all.115 This is printing techniques arrived on the scene.70 Using DNA probe technology similar to that cells.23 The damage, much like in diseases like In order to isolate a specific bug from the hepatitis, comes from the hosts’ reaction to multitude that exist naturally in the intestine, amounts of DNA, one can determine the def- it. MAP triggers a massive immune reaction one has to devise a decontamination technique inite presence of paraTB without needing to against the body’s own tissues in which MAP that kills other bacteria without harming the actually culture and grow it.144 No longer is hiding, in this case the gut.26 It is known target bacterium, in this case MAP. Without their protective cell walls, however, cell wall years for the spheroplasts to revert back to Johne’s disease in cattle, but does it cause deficient forms are almost impossible to cul- normal and start growing again, one could ture because of the caustic processing tech- just target, with 100% certainty, MAP DNA.
Even once isolated, MAP is very difficult Crohn’s patients came up positive, compared Paratuberculosis bacteria seem to cause dis- to grow.68 Researchers have been trying since to only 4% of those with the similar but dif- ease in almost every species of animal so far 1952 to grow mycobacteria from surgically ferent disease ulcerative colitis.170 As techniques studied.75 It’s reasonable to assume the same removed Crohn’s disease tissue.46 It is thought for extracting and isolating DNA have become better and better, MAP has been found in intes- specific chronic inflammation of the intestines failed because of his many years of experi- tinal Crohn’s tissue with increasingly positive of cattle, sheep, deer, rabbits, baboons, and ence, combined with access to modern cul- results.112 The reason more Crohn’s cases were three other species of primates.115 The prob- ture techniques and years of patient work.126 not detected is because the test has a limited lem for Dalziel was that he couldn’t visualize Some human isolates took up to six years to sensitivity, especially when searching for a the bug microscopically in the surgically grow, even under extremely precise culture needle in a haystack in the gut which is awash resected intestines of patients with Crohn’s.61 and decontamination conditions.66 Earlier in the DNA of billions of other bacteria.153 DNA While one can easily pick out MAP in most researchers failed to meet these stringent probe detection of other low abundance bac- cases of Johne’s disease with a simple light terial pathogens, particularly in chronically microscope, to this day attempts to stain and inflamed tissues—diseases like tuberculosis, view MAP in Crohn’s disease has been large- relying on faulty study design.66 Moreover, the Lyme disease, brucellosis, and lymphocytic ly unsuccessful.4 The landmark of most myco- differences in methods used between labs can leprosy—have similarly been fraught with dif- bacterial infections is the presence of acid-fast be vast.24 Some labs still use fixed or frozen ficulty.155 Isolating chromosomal DNA from bacilli, so called because the mycobacterial specimens or use only surface tissues from mycobacteria in general is experimentally cell wall soaks up and retains a particular acid superficial biopsies, when it’s been shown that difficult.154 There are also other substances stain.27 Although failure to see acid-fast bacilli one should optimally use fresh66 resected in the gut that have been found to inhibit the in general is not uncommon,24 in the intestines tissue, as MAP tends to be found deep in the test such as bile salts and polysaccharides.192 of Johne’s disease infected cattle, one can see intestinal wall.166 Some labs working with non- Also accounting for uncertainty in the data27 swarms of acid-fast bacilli; in Crohn’s there spheroplast forms of MAP from cattle haven’t is the frequent misdiagnosing of Crohn’s dis- are none. The mystery wasn’t solved until 1984, even been able to grow it. Even under the best ease. For example, it’s been shown that at when Rodrick Chiodini, a microbiologist at circumstances, MAP is a tough bug to grow.67 least 20% of people diagnosed with Crohn’s Brown University’s Rhode Island Hospital pub- actually have a different disease, such as ulcer- lished a landmark study in which he actually eluded our attempts to grow them in labs at ative colitis.186 There is also considerable debate cultured live paraTB germs from the gut walls all. For example, scientists have never been able on whether or not Crohn’s is a single disease to isolate Mycobacterium leprae, the microbe entity in the first place.23 Crohn’s may be more responsible for leprosy. Even Campylobacter, of a catchall syndrome describing a number paratuberculosis (and some other mycobac- which we now know as the most significant of different conditions, some of which may teria186) can shed their cell walls and exist as bacteria in food poisoning, wasn’t identified not be caused by MAP.132 Either way, this makes what has been termed “cell wall deficient” as a human pathogen until the 1970s, when it difficult to interpret data that show that not or “spheroplast” forms. Since it’s the cell wall culturing techniques enabling isolation were all of those we consider to have Crohn’s dis- that picks up the stain, this form of the bac- teria cannot be detected using the acid-fast As expected, some people without Crohn’s— in Crohn’s, there seem to be very few MAP actu- healthy controls—test positive. Yet just because reform its cell wall even years later and revert ally involved in the disease process. This has someone comes in contact with and harbors back to its normal stainable self, which is what a parallel in other animals—MAP bacteria in a specific germ doesn’t necessarily mean that happened in Chiodini’s lab.65 It is thought that sheep and goat paratuberculosis are often person will come down with the disease.65 It this cell wall deficient form is responsible for sparse or even undetectable147—and in other is estimated, for example, that only a third of Paratuberculosis and Crohn’s Disease: Got Milk? calves that ingest MAP ever develop Johne’s.26 is known to be the cause of leprosy, and lep- the regions in which there is a high prevalence It is also possible, like closely related sub- rosy is known to be an infectious disease.105 of Crohn’s should overlap with the regions species, that there are different strains of MAP, So while not absolutely necessary to fulfill Koch’s with a high prevalence of paratuberculosis.
some of which cause disease and some of which postulates to prove causation, they are the most While sufficient data is lacking,161 a review of don’t.163 The important point is that there has widely accepted method. So researchers set the epidemiology of Johne’s disease compared consistently been a highly significant specific out to the task and they succeeded—twice.126 with the epidemiology of Crohn’s disease association between Mycobacterium paratu- Chiodini fed chickens pure cultures of the found just that.120 “Crohn’s disease has a paratuberculosis bacteria he recovered from very spotty distribution in the world,” notes the surgically removed intestines of children Dr. Walter Thayer, an expert on the disease Association or Causation?
with Crohn’s disease. The chickens then devel- Just because Crohn’s sufferers are much more oped an intestinal disease resembling Crohn’s.108 Chiodini to culture MAP from Crohn’s patients.
likely to have MAP found in their gut does not In 1986, a different lab fed infant goats a human “But it’s seen only in milk-drinking areas— necessarily mean that MAP caused the disease.
strain of paratuberculosis and also found that Australia, southern Africa, Europe, the United Another explanation of the finding could be the bacteria induced a Crohn’s-like intestinal States, Canada, New Zealand. Interestingly, that this is just an opportunistic invasion of MAP disease in the goats. The same strain was then it’s not seen in India, where they do drink milk, into diseased tissue, leading to a chicken and recovered back from all of them.191 When asked egg scenario of which came first.184 If MAP why there continues to be so much resistance Critics point to Sweden, which has its share just has an affinity for inflamed tissue, how- against the idea of MAP as a cause of Crohn’s of Crohn’s, but whose cattle are reportedly para- ever, one would expect that one would also disease, Chiodini replied “What you have to tuberculosis free. Unfortunately, the surveillance find MAP more frequently in biopsies of sim- realize is that there is a lot of politics in medi- testing has been limited.115 Michael Collins, ilar diseases like ulcerative colitis, but this is cine. It’s not whether you have the proof of not the case. Conversely, if you look for the something, but whether or not the medical University of Wisconsin, has written “We DNA of other nonspecific mycobacteria, one believe no region in the world is free of M.
finds that they are uniformly distributed paratuberculosis infection in its ruminant between Crohn’s patients versus controls. This failed attempts to figure out the cause of livestock. In all likelihood, Johne’s disease is finding is consistent with the known environ- Crohn’s, the medical community is very leery to be found in every country. Being free of mental distribution of mycobacteria, which of new proposed causes, especially infec- the disease is probably more a function of are present in 30–50% of all environmental tious ones.24 The gastrointestinal community how hard one has looked than a true lack of samplings—including water, soil, even air.24 maintains a healthy skepticism regarding new incidence.”35 We will see a prime example of So other mycobacteria people routinely come pathogens as the cause of Crohn’s disease, in contact with, even the closely related because different pathogens suspected in the Another perceived inconsistency in the link Mycobacterium avium subspecies silvaticum, past, such as chlamydia and measles, have between paraTB and Crohn’s is the fact that are equally distributed among people whether since been disproven.143 Of all the pathogens Crohn’s is found more often in urban, rather they have Crohn’s disease, or colon cancer, or once thought associated with Crohn’s in the than rural populations.143 Dairy farmers, for are completely healthy as one might expect.109 80 years it’s been researched, MAP is the only example, do not seem to have higher rates In medicine there is a method used to try one directly cultured and the only one capa- of Crohn’s.82 This is not dissimilar from other to prove that a specific pathogen causes a spe- ble of causing pathologically indistinguishable parallel diseases like bovine TB—tuberculosis cific disease. The first person to definitively prove not paratuberculosis—which, centuries ago, that a disease was caused by a particular organ- The way that doctors test for the presence was responsible for the deaths of hundreds ism was Robert Koch, who uncovered the bac- or absence of many infectious diseases is by of thousands of children who drank unpas- terial origin of anthrax in 1876. Koch cultured looking for specific antibodies that our immune teurized milk.7 The association between tuber- the bacteria from a diseased animal, gave system uses to target the invader. When we culosis contracted by drinking milk and the anthrax to a healthy animal by inoculating her test for HIV, for example, we are not usually rural community was also weak, presumably or him with a pure culture of the bacilli, and then testing for the virus directly, we are looking because of the commercial marketing and dis- was able to recover and reculture the bug once for the presence of anti-HIV antibodies.173 If again.14 These experiments fulfilled criteria pro- they’re found, we can be relatively certain the Any explanation of Crohn’s would have to posed 36 years earlier by Henle as necessary account for the rapid increase seen in this dis- to establish a causal relation between a spe- ease this century.178 The longest continuous study cific agent and a specific disease. These cri- antibodies. Unfortunately, scientists have had of the incidence of Crohn’s disease is from Wales, teria are now known as the Koch postulates.90 difficulty finding an antibody which is specific which reports a 4000% increase of the disease since the 1930s.140 This may be explained by unethical,162 they also can be unreliable in clin- suspects, however, which are thought to be the concurrent rise in paratuberculosis in inten- ical medicine, as other animals may not be sively farmed dairy herds throughout the cen- susceptible to the same diseases that we are.
of Crohn’s patients, but in less than ten per- tury.66 Thayer asks also “What has happened For example, the case to prove that H. pylori cent of those with ulcerative colitis.165 These to dairying in that time? Do you get milk from caused ulcers was hindered by animal research, results not only support the theory, but open your local dairy? No. You get it from big con- as rats and pigs were tested and seemed to new research frontiers. A vaccine might be glomerates that buy from local dairies and be immune.107 For this and other reasons, there developed and the diagnosis of Crohn’s may pool all the milk. I think this is possibly the are some recognized infectious diseases which reason the disease has spread so quickly.”19 have never fulfilled Koch’s postulates. Leprosy,for example, has still never fulfilled more than Epidemiology
Nick Barnes
one of the four criteria, because it is not pos- Other potential lines of evidence include popu- Two centuries ago, when milk drinking children sible to culture the culprit bacterium in the lab- lation studies. One would expect that if para- were dying en masse from bovine TB, one of oratory. Nonetheless, Mycobacterium leprae tuberculosis was causing Crohn’s disease, then the earliest signs that they had drunk milk Paratuberculosis and Crohn’s Disease: Got Milk? from a tuberculous cow was an infection of the ordinary tablets readily available to doctors Adequate treatment duration had also been lymph nodes that drained the throat. Scientists could make it go away. And it still took eight neglected. Mycobacterial infections in general think milk is also the source for human expo- years for the penny to drop. Now we’ve got are difficult to eradicate; prolonged treatment sure to paratuberculosis, so they wondered a bug [MAP] that you can’t see, can’t grow, hides is required and relapses, either on treatment if the same thing happened with MAP.
under the immunological radar, is a bastard or off treatment, are common.156 Tuberculosis to kill, and the problem it’s causing is far, far takes months to treat; leprosy takes years— developed a painful swollen lump on the right greater. If Rod Chiodini and I are wrong, the sometimes a lifetime—to treat. Our best esti- side of his neck. His family took him to see their magnitude of the problem will only be the mate of how long it might take to rid the body doctor, who decided it needed to be biopsied.
economic losses of farm animals, which is cost- The biopsy clearly showed he was infected with ing the United States somewhere between $1.5 in the same species. Infections caused by one paratuberculosis. This is significant because and $2 billion a year. If Rod Chiodini and I are of MAP’s closest cousins (M.avium intracellulare) it was the first definitive proof that paratu- right, then, oh dear, oh dear. We have a big routinely require treatment for 3–4 years with problem. It’s going to take a lot to put it right.”19 3 or 4 different antibiotics.71 In some cases, it cause disease. He and his family waited. Five took five antibiotics all used in combination Antibiotics for Crohn’s
for 5 years before clinical improvement was Crohn’s disease.68 Despite the clear-cut case The lesson researchers learned from stories achieved. We cannot expect trials using too like H. pylori 90 was that their best bet at con- few drugs, the wrong drugs, or even the right vincing the world that MAP causes Crohn’s lay drugs for too short a time, to be successful.21 Crohn’s, the medical community continued in trying to cure Crohn’s—a disease thought incurable—with appropriate antibiotics.74 Of any trial, even if the agents are chosen and MAP. There are many precedents of similar course, there was no guarantee that even if used appropriately. Crohn’s can be a cyclical resistance to new ideas in the medical field.
disease, with periods of flare-ups and remis- would respond to treatment.156 For example, sions, so approximately 20% of Crohn’s patients H. pylori
during a treatment period will spontaneously Most ulcers are caused by the immune sys- biotics, but when TB bacteria move from the improve on their own. The placebo effect is tem attacking the lining of the stomach.
lung to the intestine and cause intestinal TB, also expected to play a role in 30–40% of Doctors blamed stress, thinking this led to too it cannot typically be cured by antibiotics patients undergoing short-term therapy. And much stomach acid and the excess acid caused alone.23 Researchers, though, set out to try.
as mentioned previously, Crohn’s is a poorly irritation which maybe triggered the attack. It Before we knew that ulcers were treatable delineated disease—20% of people diagnosed was treated the same way as Crohn’s has been with simple antibiotics, people underwent with Crohn’s may actually have something treated: symptomatic relief of the inflamma- repeated grueling surgeries—some almost as else.186 There is also clinical, epidemiological, tion and surgery. Then two Australian researchers risky and debilitating as Crohn’s sufferers and molecular evidence indicating that there cultured a tiny bacterium from the lining of are two distinct clinical manifestations of the stomach and hypothesized heresy—that Crohn’s sufferers from the surgeon’s knife, Crohn’s disease, which each may respond dif- ulcers were actually caused by an infection.99 but it would also protect them from the toxic ferently to treatment. These factors make it dif- For almost a decade the researchers’ ideas chemotherapy regimens currently used just ficult to evaluate any therapeutic intervention.150 were dismissed and ridiculed.39 The medical for symptom relief, which can include immuno- Despite these hurdles, the latest results are community scoffed at the notion that bacteria quite promising.74 Instead of just blindly trying could survive in stomach acid.107 One of the different antibiotics, scientists actually endured Australian researchers was so desperate that Researchers started trying antibiotics they the laborious task of testing the antibiotics one he actually drank a vial of the bacteria to prove thought might kill MAP in Crohn’s. Early results by one on MAP in the lab. The breakthrough his point.99 What finally convinced the med- were disappointing,156 leading to much of the came in 1992 when the newly developed antibi- ical community, though, was that ulcers dis- deep-seated resistance among clinicians to otic clarithromycin was found to be the most appeared when patients were treated with the accepting MAP as the cause of Crohn’s.14 Yet effective known killer of Mycobacterium paratu- right antibiotics.64 This discovery revolution- in hindsight, it turns out that doctors were berculosis. Many of the antibiotics used ear- ized thinking in medicine. The ulcer-causing using the wrong antibiotics, in the wrong com- lier worked by blocking cell wall synthesis. But bacteria, H. pylori, is now known as the cause binations, for an inadequate period of time.
Crohn’s is thought to be caused by the sphero- plast form of MAP which doesn’t have a cell Many scientists see a close parallel between many researchers assumed that antibiotics wall; it’s therefore no wonder these earlier drugs the H. pylori story and paraTB. Just as H. pylori effective against M. tuberculosis should also didn’t work. Clarithromycin, and an antibiotic bacteria were the real reason the body was be effective against M. paratuberculosis.189 They called rifabutin, have a different mechanism attacking the stomach lining in ulcers, researchers were wrong; when one actually tested anti- of action, blocking protein synthesis.157 think that the MAP bacteria are the reason the biotics against MAP in a lab, researchers body is attacking the intestinal lining in Crohn’s.
found that it was in general resistant to anti- mycin (called macrolides) work against paraTB The proposition that ulcers were an infectious tuberculous drugs.22 They didn’t work in where others have failed is that MAP is an disease was met by nearly universal skepticism intracellular pathogen. They live inside our in the medical community.107 As Dr. Hermon- cells (another reason why they’re so hard to Taylor, Chairman of the Department of Surgery see under a microscope). Only certain antibi- at St. George’s Medical School in London and that they only used a single agent—which is otics, like macrolides, can penetrate inside leading proponent of the paraTB-Crohn’s link, rarely, if ever, effective in mycobacterial dis- human cells and still work effectively.157 None has noted, “And this [H. pylori ] was a bug that eases because mycobacteria are so adept at of the previous MAP trials properly evaluated you could see by looking down the microscope, developing resistance.22 By giving multiple these newer macrolide antibiotics.60 The time grow in a simple culture system in the lab, antibiotics at once, one decreases the chance was ripe for a trial of these newer agents in test for immunologically pretty simply, and Paratuberculosis and Crohn’s Disease: Got Milk? An Attempt at a Cure
what I’ve got.”19 To date, according to the For example, people should not let those with The first trial took place in London, published Cleveland Free Times article that won 1999’s 1997.60 Researchers chose to use rifabutin Project Censored Award, twenty-five of Hermon- Taylor’s grant proposals submitted both here Johne’s disease is how people are exposed to complement or synergize with each other.157 paratuberculosis. Based on DNA fingerprinting Chiodini estimates he’s similarly submitted techniques, there are two strains of MAP: one over two dozen grant proposals to the National that affects cattle, and one that affects goats Fifty-two patients with Crohn’s disease, most Institutes of Health, the USDA, and the Crohn’s and sheep. All human isolates so far have been and Colitis Foundation of America, but to no of bovine origin,24 implicating milk.11 Milk is the resistant to conventional treatment, were avail.19 Drug trials run in the United States have “logical” focus of exposure24 because cows studied. Six patients had to be excluded, due traditionally been supported by the pharma- with Johne’s disease secrete paraTB abundantly mostly to intolerance to the antibiotics,60 ceutical industry, but just as H. pylori threat- in their milk.158 Even sub-clinical cows—those though in general the RMAT medications tend ened to deprive some of the largest corporations that are infected but appear perfectly normal— to have a much higher tolerance rate and far in the world of billions of dollars (anti-ulcer shed paraTB bacteria into their milk.24 Although fewer side effects than the current immuno- medications were the world’s best-selling these bacteria are found free-floating in milk, suppressive drugs used for Crohn’s.120 The prescription drugs), the drug industry scores their transmission may be facilitated by their remaining 46 patients were treated with RMAT huge profits from increasingly complex and presence inside pus cells.158 This is a particu- for about a year. Of the 46 patients who were expensive maintenance Crohn’s treatments, lar problem in the United States, as we have able to tolerate RMAT, 43 went into clinical which must be administered for the rest of the highest permitted upper limit of milk pus remission, for a remission rate of 94%.60 the patient’s life.107 Needless to say, financial cell concentration in the world—almost twice support from the corporate sector has not been the international standard of allowable pus cells majority of patients in whom a clinical remis- (750,000/ml vs. 400,000/ml)168 By US federal sion was initially induced remained symptom law, Grade A milk is allowed to have over a free off of all their previous medications.60 must be reproduced to be seriously considered.
drop of pus per glass of milk.6 These pus cells Similar trials in other centers have reproduced Larger scale controlled studies are currently may facilitate the transmission of paraTB.158 these findings.9,10,16,44,167 The fact that some in progress to obtain better data.161 The most patients relapsed after treatment was stopped promising is a phase III clinical trial of RMAT Pasteurization
may point to the difficulty in eradicating the in Australia which has been designed as a In England, researchers took milk off grocery organism or perhaps that they had been re- double-blind, multi-center, controlled clinical shelves and tested it for the presence of para- infected.61 Hermon-Taylor, one of the principal trial involving over 200 patients with Crohn’s tuberculosis bacteria using DNA probes. Depend- investigators of the original trial, is currently in at least seven major cities across the conti- ing on the time of the year, up to 25% of milk recommending patients take RMAT regimen for nent.125 Unfortunately, they seem to be having cartons contained paratuberculosis DNA.104 at least 2 years. Among patients who respond a problem securing patients for the study.111 Interestingly, the seasonal variation coincided to treatment, remission occurs slowly over the A controlled RMAT trial has also reportedly been with the periods when Crohn’s patients tend first three to six months of treatment. Symptoms initiated by the National Institutes of Health.39 to suffer relapses.61 The researchers tried to cul- often get worse before they get better, as in ture live paraTB bugs from the milk, but were the drug treatment of other chronic mycobac- Milk and Pus
largely unsuccessful, because cows’ milk is such terial diseases such as leprosy, perhaps due Professor Hermon-Taylor, internationally known a stew of microbes that fungal overgrowth and expert on Crohn’s and MAP genetics, who has faster multiplying bacteria took over the sam- researched the illness for 20 years, said: “If there ples.159 The question then remained, did the highest reported remission rate of any known were no MAP I believe there would be almost positive DNA samples in up to a quarter of the treatment for Crohn’s disease and the lowest no Crohn’s disease. It is certainly responsible milk supply indicate live or dead paratuberculosis reported relapse rate, including all current for between 60 per cent and 90 per cent of all bacteria? Can paraTB survive pasteurization? immunosuppressive treatments.120 Thought to cases and I would think that it is more likely Historically, pasteurization had been estab- be an incurable disease, doctors seem to have to be 90 per cent.”110 Obviously, everyone who’s lished in order to kill paraTB’s cousin, bovine been able to induce profound long-term remis- exposed to paraTB doesn’t come down with tuberculosis.179 TB was thought to be one of sions in the majority (68.7%) of patients with Crohn’s disease, as is the case in virtually all Crohn’s disease.12 Not only do patients stop infectious diseases. As mentioned previously, so the temperature was set at approximately having symptoms, but their intestines actually just because one comes in contact with a path- 62° C (144° F) for a half an hour.179 Later, the show evidence of healing, an unprecedented disease Q fever (caused by Coxiella burnetii ) achievement.164 “If this were cancer,” said one down with the illness. Genetic and environ- RMAT researcher, “we would be calling these mental factors facilitate establishment, per- increased to 63° C.180 Now the HTST method, long remissions a cure.”98 Hermon-Taylor told which stands for High Temperature, Short Time, the press “I’ve seen people who were with- is predominantly used—72° C (162° F), but out hope get better like magic. I’ve been a ulcers), for example, is one of the most com- only for 15 seconds.93 While 72° C kills most doctor for nearly 40 years, and it’s the best mon of all bacterial infections90—a third of bacteria, paratuberculosis has been shown thing I’ve ever seen in clinical medicine.”19 Americans have H. pylori in their stomachs.99 to survive 15 seconds at 90° C (194° F).58 By Though the preliminary results of this and A third of us, however, don’t have ulcers;64 some hiding in milk in fat droplets, pus cells, and other pilot studies are encouraging, Hermon- people are susceptible and some are not.
fecal clumps,189 paraTB might be able to sur- Taylor is the first to point out the limitations Similarly, only about one in three hundred vive at even higher temperatures.59 Second of the study—it was too small and there people exposed to tuberculosis actually come only to prions137 (which cause mad cow dis- were no controls.185 “We were actually denied down with active disease.19 Until we know why ease), paratuberculosis is considered the the funding to do a randomized control trial,” some and not others fall ill, all one can do most heat-resistant pathogen in the human he said. “So I did the best that I could with is to try to minimize exposure to the pathogen.
Paratuberculosis and Crohn’s Disease: Got Milk? Johne’s on the Rise
sound waves, and freezing them—a technique large and small.36 Six grew out live paraTB, that has been shown conclusively to weaken 19%—almost 1 in 5.65 This caused a national Organization of the United Nations, Johne’s MAP.56 They were also criticized for making a food scare with daily front page headlines, disease is one of the most serious diseases number of methodological mistakes and omis- not a word of which crossed the Atlantic.
affecting the cattle industry.139 Although it is sions.18,124 Then, allegedly to make absolutely In an editorial entitled“Media and Censorship,” found in cattle populations throughout the sure not a single bug would grow, they used the editor-in-chief of the Cleveland Free Times an inadequate culture media124 and report wrote: “The dairy lobby is notoriously power- the worst paratuberculosis problem on the culturing them for only 2 to 3 months.172 It is ful inside the Washington DC beltway. And a planet.122 In 1997, the USDA released a long- widely accepted that the minimum time it takes tax on dairy farmers helps the dairy industry awaited report of the national prevalence of to ensure the growth of paraTB is 4 months.124 spread its advertising dollars around generously Johne’s disease. Surveying over 2500 dairy (most notably the ‘Got Milk?’ ad campaign), producers,190 they showed that between 20 and grew from the pasteurized milk in their experi- to the point where the wholesomeness of milk 40% of US dairy herds were infected, a figure ment. The researchers concluded: “Results goes virtually unquestioned in the media. How that they concede is probably an underesti- indicate that the transmission of live paraTB else can it be explained that the possible link mate.190 Since milk from an entire herd is like- bacteria via pasteurized milk is unlikely.” between a bacterium in milk and Crohn’s dis- ly to be pooled together in tankers for transport Despite fifteen19 years of better research to ease is virtually unknown in the United States, to processing plants, all the milk from 20 to the contrary,121 based on that single question- despite front-page coverage in England and 40% of US dairies is likely to be contaminated.85 able study, in a letter dated February 9, 1998, Just as Crohn’s disease is increasing in the Joseph Smucker, the leader of the FDA’s Milk human population—it may be no coincidence Safety Team wrote, “After a review of the avail- released, crisis management specialists called that the United States also has the world’s able literature on this subject, it is the position the ramifications “enormous,” “horrific.” Dairy highest incidence of Crohn’s ever recorded116 of FDA that the latest research shows con- industry experts described it as a “significant —Johne’s disease is spreading among dairy clusively that commercial pasteurization does blow to the industry,” “accelerating the long- cattle.19 Johne’s disease is spread primarily by term decline of milk,” and noting “It’s not a mar- the fecal-oral route. One can imagine how a ket that can just bounce back.”198 Dairy industry cow with intractable diarrhea can thoroughly ization studies used unrealistically high levels leaders reacted angrily to the suggestion that contaminate her surroundings133 and just a few of MAP that wouldn’t be expected to exist nat- pasteurization was inadequate. The British bits of swallowed manure can potentially infect urally in the raw milk supply.201 This is not a National Dairy Council’s “Information Officer,” a calf.133 Overtly infected animals, losing up to tenable criticism, primarily because the stud- said she wished the investigators had con- 300 lb of body weight in one week106 can shed ies in question followed the published guide- tacted the industry before publishing their as many as ten hundred trillion bugs a day.30 lines on the proper challenge concentration One can also imagine what intensive modern in the design of thermal inactivation studies.57 Responding to public pressures, the British farming practices have done for the disease.85 Also, the concentration of MAP in raw milk is government initiated a nationwide thousand- Grazing bigger and bigger numbers of cattle unknown. Cattle infected with Johne’s disease sample survey of retail pasteurized milk. The on smaller and smaller plots of land is one of have uncontrollable diarrhea, which “sprays” the reasons this dreaded disease is such a out from them in liquid form. Due to the close Europe, but there was still no word in the growing threat.81 And every time animals are proximity of the cow’s anus to her udders, it American press.19 The preliminary findings of is unavoidable that an infected cow’s udders the British government’s survey were released be infected. If no changes are made, the dairy will be smeared with feces, potentially leading in April 2000. Three percent92—3 out of every herd infection rate is expected to reach 100%.115 to the contamination of her milk with high num- one hundred cartons of milk off the shelves— bers of Mycobacterium paratuberculosis.124 grew out live paratuberculosis bacteria.97,159 USDA Farce?
The feces contaminating her milk can have Based on the detection threshold of these tests, With the growing Johne’s epidemic, US gov- as many as a trillion paraTB bugs per gram.142 each quart had to contain at least about a mil- ernmental regulatory agencies have been in a bind. The only thing allegedly standing between Off the Shelf
A year and a half earlier, after the announce- people and the paratuberculosis bacterium are Despite its shortcomings, the USDA study con- ment that milk was contaminated by at least 15 seconds at 72°C.37 The government has had tinues to be cited and the rest of the scien- paraTB DNA, the three British supermarket to somehow convince the families of Crohn’s tific literature ignored by the government giants—Tesco, Sainsbury, and Safeway— patients who started to ask questions that pas- and the agricultural press.62 Hoard’s Dairyman, announced that milk pasteurization time would teurization was foolproof. The problem was that for example, cited the USDA study and con- be increased from 15 seconds to 25 seconds, the preponderance of the scientific evidence cluded that “pasteurization destroys this dan- to reassure the public that their products were was against them—almost every study ever gerous disease.”100 The year after the USDA safe.13 The finding of live paratuberculosis bac- done simulating pasteurization conditions study was published, assertions such as this teria in retail milk over a year later has fueled showed that paraTB survived the 15 seconds one were conclusively proven to be wrong.
the skepticism that the 10 second change would at 72° C.67 So USDA scientists designed their The only way to demonstrate for sure that make any difference.94 The change was not own experiment, which they published in1997.
live paraTB bacteria survive pasteurization is based on science—in fact, there is a suggestion Critics accuse the USDA of trying to ensure to culture a colony of living paratuberculosis that some paraTB can survive pasteurization that no paraTB would survive in their pas- bacteria from retail pasteurized milk off the temperatures for 9 minutes73 or longer.172 teurization experiment by first crippling the grocery shelf. In 1998, that is just what bacteria. Very irregularly, with no precedent researchers did. Choosing Ireland, which has Public Relations
in the scientific literature for using this type the highest per capita milk consumption in Despite the release of these findings, Nick of approach,56 the USDA describes beginning the European Union,117 investigators went to Brown, the British agriculture minister said their experiment by first “starving” the MAP 16 retail outlets and got 31 cartons of milk on national television: “I drink pasteurized milk bacteria,124 exposing them to high-frequency which were pasteurized at commercial dairies and it is safe to do so…with confidence,” a Paratuberculosis and Crohn’s Disease: Got Milk? claim reminiscent of a previous minister’s Paratuberculosis has been called a “spec- of operations, the cows’ udders are not rou- assurances about beef from cattle infected tral disease,”139 a “hidden threat,”171 an “insidi- tinely washed prior to collecting colostrum or with mad cow disease.196 According to the ous problem for the nation’s dairy herds.”134 Royal Statistical Society, contaminated beef Although infections are usually initiated dur- While some calves are infected in utero,32 still has the worst-case scenario potential of ing calfhood, clinical disease does not appear killing 13 million people who consumed it and until adulthood.146 During this incubation peri- immediately upon birth is considered an effec- are currently incubating the disease which od, which can last between 6 months151 and tive control measure because it eliminates the Britain’s health secretary called the worst 15 years,186 the infection is invisible.199 Sub- newborn’s attempt to nurse and risk ingest- clinically infected animals don’t have diarrhea ing infectious manure.190 Currently, about two or other typical visible signs of Johne’s, but thirds of dairy operations report taking the United States. For example, the director of the they are carriers and can shed the bacteria into calf away from the mother within 24 hours.190 USDA National Animal Disease Center, feel- the environment, giving paraTB ample oppor- ing assured that pasteurization eliminated any tunity to become entrenched in a herd before community that Johne’s disease management health threat said, “I don’t hesitate to feed it is apparent that a problem even exists.129 will intensify this irresponsible69 practice.
[milk] to my 8-year-old.”187 The FDA chooses In this way, the Johne’s disease problem Disposal of infectious feces creates quite a to continue to base national safety policy on has been likened to the tip of an iceberg— problem. Some industry specialists have advo- the single flawed USDA study,97 even now that the so-called “iceberg effect.”199 By the time cated special landfills, while others have made the study has been superseded by proof that a single clinical case surfaces, five37 to fifteen63 the potentially hazardous proposal to “as a its conclusions are wrong (the United States or twenty190 others may be infected in the herd.
last resort, spread [it] on permanent cropland.”26 mandates virtually the same pasteurization If the clinically affected animal had been born method that is used in Britain and Ireland).2 on the farm, a minimum of 25 other animals Conspiracy of Silence
The FDA’s continued insistence that pas- are probably infected—perhaps as many as Despite its pervasiveness and its ability to teurization eliminates the risk of contracting severely impact milk production and destroy paraTB—despite clear evidence to the contrary detectable by currently available tests.199 whole herds of cattle, Johne’s disease remains —puzzled Kurt Gutknecht, the editor of the Johne’s may also be clinically hard to detect.
an industry problem that is not openly dis- highly respected industry publication Wisconsin While in some instances the disease progresses cussed.106 In an article entitled “Johne’s Disease: Agriculturist. He called up Joe Smucker, the relatively rapidly, with the interval between the A Dairy Industry Perspective,” Johne’s is leader of the FDA’s Milk Safety Team, and asked described as “something that farmers talk him about the FDA’s official “commercial pas- in months, in other cases, after the initial loss about secretly—whisper behind hands.” One teurization does indeed eliminate this hazard” of condition, there may be no clinical deteri- dairy scientist stated that in all his years he statement. Smucker replied that he did not have oration for long periods of time. Since the first had never heard an open, frank discussion “clearance from the FDA” to speak to him on signs of clinical disease are progressive weight of Johne’s disease and calls for an end of the the subject. Surprised at Smucker’s reluctance loss and a drop in milk production, farmers “whispering campaign.”5 Dairy farmers try to to talk to him, the editor went to the official may just cull the animal without requesting hide the fact that they have the disease in FDA spokesperson, who described the refusal further diagnosis.148 Also, like Crohn’s, Johne’s their dairy herds.61 As an article in Cornell of an FDA official to not respond directly to press can go into periods of remission which can Veterinarian notes, “Farmers prefer not to inquiries as “very unusual.” Gutknecht turned last for weeks or even months.26 Finally, acknowledge its presence and enshroud sus- his attention back to the Milk Safety Team Johne’s can mimic other diseases like intes- pect cases with secrecy.”26 It is a problem that which no longer returned his phone calls.48 tinal parasitism, malnutrition, salmonellosis, is kept out of sight and out of mind. As one dairy farmer put it, “It’s [Johne’s] a dirty word.
however, what kind of time bomb they’re sit- Traditional control methods have involved It’s like AIDS—you don’t talk about it.”54 ting on.61 According to one industry expert, the culling infected animals and using hygiene This conspiracy of silence extends beyond incrimination of MAP in human disease would methods to prevent new infections.32 Removing the producers to encompass the entire indus- infected animals alone has proven ineffective try to the point of interfering with scientific agriculture industries. An article in Milk Science because of the latency period and because dialogue.24 From the Journal of Dairy Science: International entitled “Is Mycobacterium the bacteria survive so well outside the body.
“Fear of consumer reaction…can impede paratuberculosis a possible agent in Crohn’s As one commentator noted, “An iceberg is rational open discussion of scientific studies.”34 Disease?” warns that “the present state of not destroyed by the removal of the tip!”138 Without doubt, says Chiodini, “the dairy and knowledge is…potentially catastrophic for Another proposal has been to kill off the entire regulatory industries are concerned vocally… the dairy industry should existing information herd, an option termed “herd disposal.” The but their concern is limited to the possibility plan would then be to disinfect the barns and of ‘bad press’ to the industry rather than a concern for the truth or public health.”24 Hidden Threat
allowed to pasture. This measure will likely Johne’s disease is one of the most difficult never be initiated, though, because paraTB rance. Over a century after the disease was diseases to recognize and control.26 This is is so widespread that the resulting financial identified, almost half of all dairy farmers in part because of MAP’s ability to resist nationally surveyed by the USDA didn’t know destruction in the natural environment. It has After culling, the next most effective action anything about the disease.106 And those with reservoirs in pasture and, perhaps, in other is considered to be segregation of the infect- the largest herds—the herds most likely to ed animals.142 Strict hygiene, down to the be infected106—were found least likely to spread, for example, from dairy cattle to wild, washing of boots, is necessary to prevent cross have known of the disease.195 Karen Meyer, free-ranging white-tailed deer in the state of contamination—only a few grams of manure Connecticut.28 The chief reason that paraTB are needed to infect a calf.133 Surveys show Paratuberculosis Awareness & Research is so hard to prevent and control, however, that many of these basic steps are not followed, Association (PARA), placed the blame on the however. For example, in approximately a third representatives of the dairy industry. At a meet- Paratuberculosis and Crohn’s Disease: Got Milk? ing of the USDA’s United States Animal Health the Code of Federal Regulations (part 80) was a compulsory eradication program.189 “To min- Association (USAHA), she challenged dairy recently changed to remove restrictions on the imize the risk of human exposure to paratu- producers to become more proactive. “If there interstate movement of Johne’s disease posi- berculosis” is one of the explicit reasons given are organizations you have been relying on tive animals.127 The change was made because of pressure from the livestock industry.169 be closest to winning the battle, probably interests, they have failed you miserably.”118 because it was the first country whose con- “I think we underestimate farmers,” she told mouth is, the USDA insists that the agency is trol efforts were nonvoluntary.141 Australia is the Wisconsin Agriculturist. “If they even doing everything it can with regard to Johne’s currently also certifying herds with a view to thought they were making someone sick, it disease.61 The USDA, for example, cites the for- eradication.72 Although there are currently mation of the National Johne’s Working Group no restrictions on international trade as a result (NJWG) in1994. However, the executive commit- of the disease,106 that may well change and US Inaction
tee of the group is composed of three people: potentially threaten America’s $700 million dairy one is John Adams of the National Milk Producers to keep its head in the sand. Industry specialists Federation and another is Gary Weber, a direc- blame the federal government for “grossly tor of the National Cattleman’s BeefAssociation.201 the Johne’s Disease Committee and the gen- underfunding” research, with less than one For those that remember the Oprah Winfrey percent of its animal disease grant budget words: “Don’t shoot the messenger.”73 Rather allocated to Johne’s.61 As Alan Kennedy, a defending cow cannibalism. “Now keep in than participating in serious dialogue around co-founder of PARA and himself a sufferer of mind,” he said on that show, “before you—you the issue, the dairy industry has been accused Crohn’s disease remarked,“yet another case of view the ruminant animal, the cow, as simply CJD—Conflicting Job Description.” The USDA a vegetarian—remember that they drink milk.” researchers in the field,61 giving lip service, and is mandated to regulate animal industries and Years earlier, in response to activists’ requests vainly hoping it just all blows away.24 Christine food safety, but it is also responsible for pro- that farmers discontinue the practice of feed- Rossiter, senior extension veterinarian with moting these same agricultural products.201 ing rendered animal protein to animals raised the Cornell University Veterinary Diagnostic The first US case of Johne’s was discovered for slaughter, he told industry publication Food Laboratory, told the Wisconsin Agriculturist that in Pennsylvania in 1908.182 Almost a century Chemical News that the cattle industry could those who decide to address the issue are put later there is still no mandated control pro- indeed find economically feasible alternatives at risk and there’s “no value placed by the indus- to such a practice, but that the cattlemen’s asso- try on a person who wants to do something scientists published warnings of the danger ciation did not want to “set a precedent of about Johne’s. Nobody wants to take it on.”61 posed by the disease and outlined effective At an international colloquium on paratu- methods of controlling and eradicating it.
Not surprisingly, the NJWG has officially berculosis, Chiodini expressed his view that Efforts to control and eradicate Johne’s dis- come out against making Johne’s a reportable the current focus of the American dairy indus- ease have been grossly inadequate.61 “In the disease, advocating that all attempts at con- try “could put the industry in the same light 75 years following the release of that publi- trol be voluntary.169 In a moment of rare can- as the tobacco industry, being accused of a cation, there’s very little that any state has dor, one NJWG member explained why:“If the cover-up and faced with all sorts of liabilities.”24 done to try to control the disease,” says farmers have to report positive cows, then it Paul Strandberg, Assistant Attorney General Collins, the University of Wisconsin veterinary will be like the sheep scrapie [mad sheep dis- of the State of Minnesota warned the Johne’s researcher. Meanwhile, as predicted in 1922, ease] program. Instead of reporting the disease, Disease Committee that if they chose to be the disease has continued to spread silently the farmers will ‘shoot, shovel and shut up.’”119 less than forthright about the possible link and surely. According to the USDA’s figures, A year earlier, a national paratuberculosis between milk and beef and Crohn’s Disease, there are now three quarters of a million cat- certification program had been started in order they could wind up on 60 Minutes in the mid- tle infected with paraTB in the United States.130 to identify low risk herds, but only 1% of dairy The reason that Johne’s has spread to such operations reported participating in the program, a degree is because there have been no direct citing associated costs.190 Less than 15% of Off the Shelf USA
constraints on the transport of infected ani- the dairy producers appear to test for Johne’s.106 In order to put the problem in perspective and mals.142 Almost without exception, paratuber- In 1997, the NJWG set up a similar program get the issue out in the open, the consumer culosis is introduced into a herd through the designed to be more affordable,15 but again movement needs to get a study of retail milk addition of an asymptomatic, infected carrier chose to keep it strictly optional, relying on the supplies in the United States funded. That is animal. Almost every infected herd can trace “livestock industry in each state to sell its eco- the recommendation of PARA.121 That is the the infection to the purchase of an infected nomic advantage to its members.”169 As a con- recommendation of researchers in the field.124 cow183 that appeared healthy when offered cession to the industry, there is still no federally Not only has industry allegedly “totally ignored” for sale.194 Disturbingly, the USDA found that mandated Johne’s disease control program.169 this approach,24 one observer wrote that it dairy farmers with infected herds were no less Some states have Johne’s control programs, would be “political suicide” for a researcher likely to sell replacement cows to other farms but without exception they are noncompulsory.123 in the United States to even suggest such a Just as government deregulation of indus- thing.61 However, there have been two brave Regulatory vets know and accept this fact, try may have led to the mad cow disaster in souls. Year after year, Chiodini and Hermon- acknowledging that movement restrictions on Europe, the lack of industry accountability may Taylor, world-recognized authorities on MAP infected animals must exist for an effective also play a pivotal role in the human conse- and Crohn’s, have submitted proposals to the control program. However, as described in the quences of the paratuberculosis epidemic.114 USDA and to the FDA to test retail milk sup- Veterinary Clinics of North America, “if the vol- The United States is being left behind in plies, and year after year their proposals have untary program imposes movement restrictions, the worldwide race to eliminate paraTB.118 The it could quickly become a regulatory program Netherlands, one of Europe’s largest dairy and not have widespread support and partic- exporters, has pledged to eradicate paratuber- was debated on whether or not to recommend ipation from the livestock industry.”169 In fact, culosis by the end of this year by instigating that the USDA test retail dairy products in Paratuberculosis and Crohn’s Disease: Got Milk? the United States for the presence of live The financial impact of paraTB is enormous;30 stream, infecting her internal organs, and pos- paraTB bacteria. John Adams, the National Milk paratuberculosis currently costs the American sibly her muscle tissue (so far, no one has tried livestock industry over a billion dollars a year.61 culturing MAP from a cow’s muscle tissue).
the NJWG, was quite vocal in his opposition: A collapse in consumer confidence could raise Even if the muscle tissue didn’t contain large “The FDA has already stated their position.
numbers of MAP before the infected cow’s They are confident that pasteurized milk is “If MAP is ultimately shown not to be the death, when she’s slaughtered it seems impos- safe. We don’t need to test retail milk.”119 cause of Crohn’s disease,” Chiodini argues, sible to ensure that feces do not contaminate “then the industries have taken the appropri- the various tissues that are taken from her, whose wife has suffered with Crohn’s disease ate position of ‘lip-service,’ to give an image as evidenced by the numerous E. coli food since 1960,19 replied: “With all due respect, sir, of concern.”24 If, however,—as PARA phrased poisoning deaths in recent years.123 As a sci- if milk is as safe as you say it is, then retail test- it in an open letter to the industry—”dairy entist put it: “Consequently, both preharvest ing will simply confirm that fact.Are you afraid products become associated with the dread- and postharvest contamination of food prod- of retail milk testing because you are afraid ful, life-destroying disease known as Crohn’s ucts originating from cattle is plausible.”34 of what you might find?” The resolution was disease, your markets may also collapse and Although Americans eat 2.6 billion pounds voted down by an overwhelming majority.119 may never recover. The image of dairy foods of culled dairy cows annually, most hamburger PARA kept at it. Finally, in 1999, PARA suc- as being necessary for good nutrition, care- meat comes from cattle raised for beef. In 1984, cessfully submitted two resolutions to the about one percent of US beef cattle were found Johne’s Disease Committee, one recommend- positive for Johne’s disease. Research is ongo- ing the testing of retail milk and milk products ing at the USDA to determine the current preva- for the presence of live MAP and another rec- Other Dairy Products
lence of Johne’s disease in beef cattle, but since ommending research to determine what cook- At the present time, only testing of milk has Johne’s is such a hidden disease, is not report- ing temperatures are needed to reliably kill able, and is not the subject of a mandatory MAP in ground beef. Although both resolu- Kingdom). All other dairy products have been control program, one might suspect that the tions passed unanimously in open committee, neglected (cheese, yogurt, etc.). The only safe incidence has increased significantly as it has policy would be either to test all milk before in the dairy cattle population.123 In spite of this it is used to make other dairy products or to situation, lack of awareness among beef pro- on record as deliberately choosing ignorance test all dairy products. One third of cheese ducers is even greater than in dairy producers.
about the presence of MAP in food products produced in the United States, for example, The USDA Center for Animal Health Monitoring reports that 69.8% of US beef producers “had The USAHA tried to justify why the resolu- which one could expect the highest levels of not heard of it [Johne’s] before.” And less then tions were quashed: “During the discussions paraTB bacteria.101 Cheese manufacturers rely 10% of producers had any knowledge beyond of these resolutions, there was much concern on the salty acidic environment of cheese to about the feasibility of end-product testing inhibit bacterial growth,181 but MAP is resist- of milk and meat for an organism that sci- ant to such conditions.181 Even less robust cooking temperatures. Mycobacterium para- ence has not confirmed as being the cause mycobacteria can survive in soft cheese for of Crohn’s in humans, and the usage of this at least 3 months and in hard cheese for up mycobacterium present in retail beef.103 Even information.” In the opinion of PARA, as to 10 months.76 Reportedly, at the University well-cooked meat may contain live paraTB.
expressed in a letter to the USAHA president- of Wisconsin, there is currently a research elect, “this statement presents USAHA as not project which is investigating the survival of cooked to 71° C (160° F). An unpierced roast only primarily self-serving, but further, is Mycobacterium paratuberculosis in cheese.86 or steak need only reach an internal temper- blatantly contemptuous of both its own mem- Since MAP can survive freezing for at least ature of 63° C (145° F). Studies show prolonged ber producers and the American public.” The a year,88 products such as ice cream may also exposure to at least 74° C (165° F) may be nec- letter concludes “We at PARA are saddened be implicated.26 Ice cream may also come from essary to eliminate the paratuberculosis bug.123 that USAHA has chosen to be part of the prob- less rigorously pasteurized milk.121 Other dairy Mycobacterium paratuberculosis is also resist- lem rather than part of the solution.”119 products like butter, yogurt, and infant for- ant to nitrites and the smoking process used mula must also be high research priorities.124 in sausage production.102 MAP may contami- Gambling with Lives
nate other meats as well—paratuberculosis The USAHA statement reveals the gamble the industry is willing to take. In Britain, when asked what the industry planned to do about when a cow is diagnosed with Johne’s is to than meat, though, in regards to paratuber- paratuberculosis, spokespersons said that have her sent to slaughter. Beef from Johne’s culosis. MAP is thought to survive digestion it was “something that bears watching”201 cattle is not prevented from being sold for when carried in a vehicle like milk, because— but that they “preferred to defer action” until as designed by nature—milk buffers the stom- paraTB is proven to cause disease in humans.84 losis is not officially considered a human ach environment to a near-neutral pH. In meat This sounded all too familiar to the British pathogen. End-stage animals, their bodies drip- however, MAP’s ability to survive digestion public after the mad cow debacle, where the ping with literally trillions of paratuberculosis bacteria, are ground straight into hamburger lost.177 According to some social science meat.123 When Crohn’s patient advocates found studies, it was the British public authorities’ out that infected tissues from animals with Municipal water supplies must also be assessed decade-long insistence on the safety of beef severe clinical paratuberculosis were funneled for risk because surface waters contaminated that did the most damage to the public trust.79 into the human food supply, they were described by agricultural run-off feed the domestic water as, not surprisingly,“abhorred and nauseated.”201 supplies of many communities in the United gambling not only with the health of con- In the advanced stages of Johne’s disease, States.115 One of the reasons why paraTB has sumers, but with their own financial health.
MAP bacteria course through the cow’s blood been called a “superbug” is because of its abil- Paratuberculosis and Crohn’s Disease: Got Milk? ity to survive in the environment for prolonged According to the chief executive of the FSAI, playing an increasingly important role in health periods.160 Mycobacteria like paraTB are one of the 7.6 million cattle in Ireland, there are only policies worldwide.51 Basically, it states, “If one of the oldest forms of life. They have survived 12 reported cases of Johne’s disease. Nineteen has a reasonable suspicion that something on this planet for over a billion years which percent of Irish retail milk samples grew out has allowed them to adapt.67 In the environ- live paraTB and researchers only found 12 cases obligation to try to stop it.”200 An ounce of pre- ment, MAP has a thick, waxy cell wall which of Johne’s disease in the entire country. Obviously, protects it121—it can last for 9 months in mud,139 as the FSAI concedes, this may be an under- almost a year in manure,76 and two years in estimate, but in the United States the paratu- On a Personal Level
water. Standard domestic water treatment such berculosis problem is exponentially worse. The On a personal level, the Crohn’s advocacy group as filtration and chlorination are probably estimated prevalence in the United States is Action Research recommends that people who some 20,000 times greater than that of Ireland.1 want to reduce their risk of infection or reinfec- tion—especially those with Crohn’s disease, or reports of MAP bacteria cultured from drink- tamination of the human food supply it should their close relatives (who might be genetically ing water, both in Europe188 and from the water be the United States, which has the highest predisposed)—should stop eating dairy prod- supply of a major American city.14 Europe’s prevalence of Johne’s disease in the world.122 ucts unless they are effectively boiled first.38 Drinking Water Inspectorate has commissioned PARA recommends that cheese should be heat- a study into the distribution and fate of MAP ed to the temperature of boiling water, 100° C in drinking water treatment;91 the same inquiry (212°F), to reduce the threat. Thus, grilling cheese under direct heat for a few minutes (so that it removal of clinically infected animals from “bubbles”), or cooking it in oven-baked meals, the human food supply alone has been mod- such as oven-baked lasagna, should effectively eled as having a highly significant impact.113 sterilize the cheese. The same applies to other serious ramifications was published in the This could evidently be accomplished with dairy products, such as milk, yogurt, or butter.86 April 2000 issue of the American Journal of relative ease, but as yet there has been little The reason the industry doesn’t pasteur- effort to do so.74 When asked how long it would ize all milk at that temperature to be safe, is Johne’s disease shed paratuberculosis into take to clean up America’s herds if suddenly because it could affect the taste of the milk.
their breast milk, researchers wondered whether no milk from Johne’s-positive cows could be As the FSAI put it, “there is an upper tempera- paratuberculosis bacteria could be detected in sold, one Johne’s Disease Committee mem- ture beyond which unacceptable changes to the milk of human mothers with Crohn’s dis- the taste of milk start to occur.”31 Steve Merkel ease. Researchers also knew that there were The consumer movement also needs to fight reports of mothers with other mycobacterial to make Crohn’s a reportable illness.92 The offi- raising the minimum pasteurization temper- diseases like leprosy shedding bacteria into cial FDA stance that pasteurization eliminates ature to levels that ensured safety regardless, their milk. So they examined two mothers with MAP is no longer tenable and must be continu- “even if it means that milk doesn’t taste the Crohn’s who had just given birth and found ously confronted with the British retail milk same as it did. Human health must take prece- paratuberculosis bacteria growing in both studies which put an end to the pasteurization the mothers’ breast milk, but not in the breast debate once and for all. An extensive Freedom milk from control mothers without Crohn’s.
of Information Act search must be initiated to answer, though. Although there is recent evi- While breast-feeding has not been found to unearth suppressed documents. For example, dence that living MAP bacteria cause Crohn’s,83 be a risk factor for Crohn’s and may, for seven years ago, Canada’s agriculture depart- even dead MAP may be able to trigger dis- unknown reasons, actually have a protective ment produced a food safety risk assessment ease.31 For example, one of the reasons that effect,143 the presence of MAP in the breast paper concluding that the paraTB-Crohn’s the vaccine for Johne’s is so seldom used is milk of mothers with Crohn’s not only adds link was something about which to be con- because it is so dangerous to handle.106 Even support to the role of MAP in the pathogen- cerned. The document, however, was stamped though the vaccine is made out of killed MAP esis of Crohn’s disease,112 but shows how new “Protected.Not for Distribution”and was as such bacteria, the human immune system can react generations could be exposed to paraTB.158 buried.19 These are the kinds of documents the so violently just to the presence of MAP pro- consumer movement needs to get a hold of.
teins, that accidentally injected into humans Recommendations for Action
In Dr. Hermon-Taylor’s view, “There is over- (or purposefully into other primates), the MAP Despite the fact that M.paratuberculosis is now whelming evidence that we are sitting on a vaccine causes a chronic progressive inflam- a known human pathogen, it continues to be public health disaster of tragic proportions.”40 mation which can last for years128 or may even tolerated in our food supply.74 After finding of Europe’s Scientific Committee on Animal Health necessitate amputation of the injection site.22 MAP in their retail milk supply, the Food Safety and Animal Welfare, however, concluded that Closely related bugs like leprosy can have simi- Authority of Ireland (FSAI) now requires that the currently available evidence was insuffi- lar effects.115 So even if MAP is pasteurized to cattle infected with Johne’s be excluded from cient to confirm or disprove the theory.145 This death, drinking the remnants of the bacteria the food supply. The flesh from an infected uncertainty should not impede the government cow is no longer considered fit for human from taking concrete steps to prevent further With this in mind, it may be more prudent consumption and her milk is simply dumped.176 potential human catastrophe. If the British gov- to avoid dairy altogether. Although ingesting Karen Meyer of PARA commented, “The gov- ernment had acknowledged the precautionary relatively few organisms may be able to cause ernment of Ireland is to be commended for principle, many lives may have been saved.
infection, the human infective dose is not exercising the precautionary principle. Instead The same exact things being said now about known.186 It is also not known how heavily the of trying to sweep the problem under the rug, paraTB,“We’ll wait and see,” were those things milk supply is contaminated in this country. The they acted swiftly to give human health pri- most esteemed pediatrician of all time, Dr.
comes around, however, it may be too late.177 Benjamin Spock, advised that children be raised The paratuberculosis problem in Ireland is vegan, with zero exposure to dairy products for minimal compared to that of the United States.
for most European environmental law and is a variety of reasons.193 Especially considering Paratuberculosis and Crohn’s Disease: Got Milk? the risk of paratuberculosis in milk, this would has led to other human tragedies including Every few hours, another child in this coun- seem sensible advice, particularly for children the single worst epidemic in recorded world try is diagnosed with Crohn’s disease and may and adolescents.110 There is a wide variety of history, the 1918 influenza pandemic.41 In that be condemned to a life of chronic suffering.62 dairy product substitutes—soy and rice milks, case, the unnatural density and proximity of The balance of evidence strongly suggests a cheeses, ice creams, yogurts, etc.—making pigs and ducks raised for slaughter led to the causative link between Mycobacterium paratu- animal-derived dairy products unnecessary.
deaths of upwards of 40 million people.87 berculosis and Crohn’s disease.145 This public This potential crisis is also an indictment of health issue has been at the periphery of the Conclusion
an industry that continues to risk public safe- dairy industry’s agenda for years, a nagging Because the spread of Johne’s disease is ty and a government that seems to protect busi- concern on the back burner.61 The consumer related to stocking density, the epidemic of ness interests over those of the consumer. As Johne’s disease is one more indictment of Karen Meyer recently told the LA Times, “There burner and needs to turn up the heat.
factory farming.3 The unnatural concentration comes a point in time where consumer health of animals raised for slaughter, for example, takes precedence over commercial concerns.”97 References
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