Public health's focus must be on the public

By Iowa City Press Citizen

----

Iowa officials have been receiving a fair share of criticism for not immediately releasing the results of the investigation into the cause of the recent outbreak of cyclospora in the state.

“This comes down to a question of balance,” David Osterberg, a professor of occupational and environmental health at the University of Iowa and the former director of the Iowa Policy Project, said in a phone interview Tuesday. “How much do you protect people and how much do you protect an industry?”

State officials need to look into the degree to which state law and policy may be tipping that balance too far away from public safety and from the public's right to know.

Throughout July, the Iowa Department of Public Health and the State Hygienic Lab have been working with Centers for Disease Control and other groups to figure out how a parasite that is relatively rare in the United States could sicken hundreds of people across more than a dozen states.

Cyclospora is not usually fatal when treated, but it's definitely no fun. The parasite can cause weeks of severe diarrhea and other illnesses that don't always manifest until long after exposure. And because it is so rare, it's not included in the first round of tests doctors usually perform. Instead, physicians have to request a patient be tested specifically for the disease.

Dr. Patricia Quinlisk, medical director for the Iowa Department of Public Health, has said those factors made it very difficult for epidemiologists to trace the source of the contagion. After all, victims often had to recall their eating history for days, if not weeks, before they tested positive for cyclospora. And then those histories had to be explored for links throughout the food production chain.

Whatever the cause for the delay, state epidemiologists and parasitologists eventually figured out that the source of the contagion in Iowa and Nebraska was some pre-packaged salad mix. But the food safety chief at the state's Department of Inspections and Appeals refused to name either the exact mix under suspicion or the stores/restaurants that carry that sold the mix.

State officials argued that - because the shelf-life for the contaminated packages had expired and because of the low probability that any of those packages were still available to the public - the public was no longer at risk. Thus, they decided, the public had no need to know which product or businesses were ever under suspicion.

Federal officials, however, came to a different conclusion, and soon after the U.S. Food and Drug Administration provided the information that state officials would not: The salad mix had come from Taylor Farms de Mexico, a processor of salad mixes sold in restaurants, and had been sold at Olive Garden and Red Lobster restaurants.

“I'm not surprised Iowa code includes provisions like this,” Osterberg said. “We bend over backwards to project agriculture all the time,” Osterberg said. “We don't want to impugn the reputation of any company even if they are giving us substandard food - or in this case, dangerous food. … Protecting companies means protecting people a little less.”

Worse, Osterberg said he thinks companies will learn the wrong lesson from the department's response to the outbreak.

“There is nothing in this case - nothing in what the IDPH has done - that will make anyone think they need to be any more careful about which Mexican company they get their cheap lettuce from,” he said.

We agree. And we would add that state officials' decision not to name the products and companies under suspicion also harms all those other companies and businesses who have played by the rules and have been following the required precautions to ensure that such a break of public health doesn't happen.

The Iowa Legislature needs to ensure that, at the very least, state public health officials are required to follow the same protocols as their federal counterparts when deciding what information to release to the public.