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In its 730-word press release yesterday on the status of its investigation into five illnesses tied to raw milk, the Kentucky Department of Public Health spent most of its verbiage warning of the dangers of raw milk. It  said almost nothing about its most vexing investigative challenge, which is to figure out how five children from a single food club served by MRM Dairy of Hodgenville, KY, became sick, when two other substantial groups served by the dairy showed not even a hint of illness.


As Kentucky health officials suggest, the fact that  “all of the children consumed unpasteurized milk” is key epidemiologically. It is “the smoking gun,” the circumstantial evidence, of where the illnesses originated. Such epidemiological connections are as key to helping unravel this cluster of illnesses as they were in 1854, when John Snow identified tainted water coming out of the Broad Street pump in London as the likely source of an ongoing cholera epidemic, and ended the epidemic by shutting the pump down….and effectively establishing the field of epidemiology. (The Ghost Map, is a highly engaging account of Snow’s detective work; this paper by Michele Jay-Russell provides an introduction to “the science and art of epidemiology”.) 


But the fact that raw milk is linked epidemiologically to the Kentucky outbreak is not an open-and-shut indictment of the dairy that produced the milk or, indeed, of raw milk itself. And that’s where the state’s ongoing investigation comes into play. 

 

The state DPH devotes only a few sentences to the actual investigation. “DPH has been working with local health departments, hospital and the provider community to investigate the outbreak,” it says. “Confirming a direct link to a given source of food or milk that causes an outbreak can be difficult, especially in situations where exposures occurred over a brief window of time. Laboratory testing has not yet definitively identified the source of the recent illnesses.”

 

What the press release is saying is that, despite intensive testing of dairy equipment, cow manure, the facilities, and milk itself (reportedly including even milk consumed by one of the sick children), the DPH has been unable to isolate a single cell of E.coli O157:H7 from MRM Dairy. This fact, along with the dairy’s very clean conditions, and the absence of coliforms in its milk before, during, and after the illnesses are all in the dairy’s favor. 


Left hanging is the main riddle confronting the Kentucky health investigators: how only one of three groups served by the dairy could be hit so hard by illnesses.


The dairy bottles milk twice weekly for three different constituencies. On Sunday, it bottles about 120 gallons, of which about 60 gallons are delivered to the Heartland Whole Life Buying Club (from which the five illnesses originated) and 60 gallons are delivered to another group of private customers. On Thursday, it bottles about 120 gallons for the Louisville Whole Life Buying Club. 


“There is nothing different about any of the milk” that goes to these three groups, according to Derek Morris, the dairy’s owner. The jars are all sanitized by the dairy’s dishwasher. Ice for the coolers all comes from the same source. They’re all delivered in the same truck. 


Since the illnesses appear to have occurred over a period of about three weeks in August, each of the three groups would have had three milk deliveries. If there was a problem with the milk when it left the dairy, you would think that illnesses would have come from two or even all three of the groups. 


Morris says he sent out emails to all recipients of his dairy’s milk as soon as he learned of the first illnesses, telling them to immediately stop drinking the milk. But aside from the illnesses among families at the Heartland Whole Life Buying Club (the five hospitalized and reports of three others with much milder symptoms), there wasn’t an indication of anyone else experiencing even the slightest symptoms from the milk among the other two constituencies. 

 

All of which raises any number of questions about the milk delivered to the Heartland Whole Life Buying Club. Was some or all of a batch inadvertently allowed to sit unrefrigerated between the time it was delivered and before it was picked up by members? Were jars handled by someone carrying the E.coli O157:H7 pathogen? Did one or more children attend an independent event, like a petting zoo, where they contracted the pathogen, and perhaps passed it around by touching milk bottles? Did some children consume a different food that was tainted? 

 

I hope the DPH investigators are seriously exploring this aspect of the case. I worry that they may not be when I hear how intensively they have investigated MRM Dairy and see certain phrases in the DPH press release, like these: “Unpasteurized milk is not safe for consumption.” “Do not purchase milk unless you can verify that it has been pasteurized.” I have not heard reports of extensive interviews taking place–the kind that would be necessary to answer the questions posed above, and others. 

 

My concern is that if the KY DPH goes at the investigation holding the belief that raw milk is inherently dangerous, then it may see no need to solve the riddle that is this case. Why try to figure out where certain milk became tainted if you believe it’s impossible to produce safe raw milk under any circumstances? 

 

Morris certainly hopes they figure it out. When the 54-year-old former aircraft mechanic first learned of the illnesses, he was ready to close up the dairy, which he launched in 2008. “Had they found I was at fault, I would have gone to the parents (of the children who became sick) and said I was done. We would have shut the doors the next day. We were putting together a contingency plan for shutting down, and putting the land up for sale, and on and on.”  

 

He adds: “That’s not why we got into this. We got into this to help people, not hurt them.” 

But now, he says, “I cannot connect the dots to us.” Indeed, now that it appears his dairy wasn’t at fault, he is preparing to fill out the 190-question form that is part of applying for membership in the Raw Milk Institute (RAWMI), and doing other things to upgrade operations. Milk being bottled tomorrow will go into plastic disposable jugs. And beginning tomorrow, his new lab will begin operating, allowing the dairy to test for coliforms and standard plate count.