E.coli O157 & Haemolytic Uraemic Syndrome

Food Standards Agency discuss burgers cooked rare at board meeting

29th March 2015

The Charity has sent the following letter to the Food Standards Agency in relation to burgers being cooked rare:

Mr Steve Wearne

Director of Policy

Food Standards Agency

125 Kingsway,

London WC2B 6BH




“RISKY” FOODS. FSA Board Paper 15/01/05

Dear Mr Wearne

As you are aware, HUSH is a charitable organisation set up by families, whose members have suffered illnesses caused by E.coli O157 infections. Some of the families we represent have suffered death, severe illness and long term complications caused by the consumption of undercooked burgers. The charity is supported by members of the medical, microbiological, public health and legal professions.

E.coli is a bacterium, many strains of which live harmlessly in the guts of humans and animals. However, strains such E.coli O157, produce harmful toxins that can cause a range of serious health problems in humans. Infection with E.coli O157 poses particular dangers to vulnerable groups such as children, the elderly, pregnant women, and those with a comprised immune system, although it has also been shown to cause serious illness in others not mentioned in the above vulnerable groups.

Our charity is opposed to the sale of rare and undercooked burgers that do not comply with the repeated advice of the Advisory Committee on the Microbiological Safety of Food (ACMSF), the body of scientific experts tasked with advising the Food Standards Agency (FSA) on exactly these kind of safety matters.

The issue has been repeatedly been examined by the ACMSF during the last twenty years, including in the report of the ACMSF Subgroup on Raw, Rare and Low Temperature Cooked Foods of June 2014, the report of the Ad Hoc Group on Safe

Cooking of Burgers. Report on the Safe Cooking of Burgers of June 2007 and originally in the ACMSF report on VTEC in 1995, which underpinned the Chief Medical Officer’s Guidance of 1998.

On all of these occasions, the ACMSF have confirmed that, for safety reasons, burgers should be cooked for 70°C for 2 minutes or equivalent. In doing so, the ACMSF have stressed the sporadic nature of the contamination, its non-uniform distribution, its low infective dose, the difficulties with sampling and the limitations of modelling. As much as detailing what is known about E.coli O157, these reports emphasise the very considerable gaps in information about the organism. The guidance is made with these uncertainties and unknowns in mind. In doing so, the ACMSF have quite correctly put public safety first and rejected lobbying from commercial interests that these cooking requirements be reduced.

In light of this, we are concerned that the FSA appear so reluctant to accept the advice of their own experts and their review of the scientific evidence. Rather the Agency seems intent in bending to pressure from businesses and a small minority of consumers (some of whom we suspect are unaware of the risks posed by raw burgers). It seems to us a case of the Agency wanting to keep on considering the matter in paper after paper until it reaches “the right decision” - being a (completely unjustified) relaxation of the current guidance.

We note that the FSA paper for the meeting on 15th January 2015 again identified the problems posed by E.coli O157 and the limitations of research conducted to date (see for example paragraphs 4.4 and 5.9-10). It is worthy of note that paragraph 5.2 of the paper states that the FSA is aware of a number of catering establishments with procedures in place to cook and serve burgers rare and that some of these establishments have procedures that result in a 4-log10 reduction in pathogens (i.e. far less than the 6-log10 reduction associated with the current guidance). It is then worthy of note that Table 1 of the paper sets out the results of the QRA modelling, with all the limitations set out in the paper, and identifies a change from a 6-log10 to a 4-log10 cooking regime leading to a three-fold increase in human infections.

The paper then identifies possible risk mitigation measures as a justification for “moving away from” (i.e. reducing) the need for the 6-log10 reduction guidance. As the paper itself makes clear, there is very considerable uncertainty about the effectiveness of these supposed risk mitigation measures, certainly nothing to justify relaxing the 6-log10 guidance.

In light of the above, we applaud the enforcement action taken by Westminster City Council against Davy’s for service of rare burgers in May 2012. We are clearly disappointed by Davy’s successful appeal to Westminster Magistrates Court. On any analysis the District Judge’s surprising ruling appeared flawed. It is therefore even more disappointing that, notwithstanding the fact that the case does not create a legal precedent, the FSA chose not to support the Council in an appeal. A national policy on as important issue such as this cannot be dictated by what appear to be the ill-informed comments of a single District Judge.

Given the legal uncertainty and the regrettable but perhaps understandable reluctance of local authorities to enforce, the FSA should be redoubling its efforts to set out its guidance and the scientific reasoning of ACMSF underpinning it rather than looking at increasingly unjustified and desperate ways to relax its guidance.

We would therefore welcome another local authority taking similar enforcement action against a restaurant serving rare burgers and would look to the FSA providing more tangible and strategic support, as befitting a Government Department responsible for protecting public health in relation to food, if the business appealed.

In relation to raw burgers, we note that most of the population choose not to eat raw or undercooked meat, yet their views are overlooked by those who have a commercial interest in charging normally inflated prices for a ‘Gourmet or different Experience’.  The consequences of any unjustified relaxation of the existing guidance in relation to the cooking of burgers in terms of an increase in foodborne illnesses may not be immediately apparent given the relatively small numbers of people wishing to eat rare burgers and the general under-reporting of illnesses and their causes. However if more and more people started choosing rare burgers, largely ignorant of the risks involved, then the consequences of a relaxation now could become increasingly apparent in future years.

This is highlighted by our consultation response to you on 29.4.14 on raw milk, where we clearly warned you, as we had done several times previously, that allowing extra sales of this product would prove to be dangerous for consumer protection. Neither the Agency nor your Focus Groups could have predicted the cases that occurred after your consultation closed and which were shown on your website.

The Agency claims to make decisions on a scientific basis. However, judging by recent events, we believe that this is secondary to the lobbying pressure applied by those interested in selling products that are potentially dangerous to consumers.

We also fear that the consequences of allowing rare burgers to be sold would not only be for the Gourmet Restaurants, but it will allow the major high street players in sales of burgers to reduce their cooking times. It would be extremely difficult to justify what would be said to be an inconsistent approach. Ignoring your scientific advisers and their assessment of the science now could have wider and even graver consequences for the future.

This we believe will lead to an increase in the number of cases of E.coli O157 and other foodborne illnesses found in raw meat. It will also make it far more difficult for EHO’s or EHP’s and others to carry out their work effectively in ensuring food safety.

As we have previously said, in the majority of cases of food poisoning, the source is never scientifically identified [looking for a needle in a haystack]. The Agency is only scientifically aware of the number of reported cases but not the actual number of cases. Government acknowledges that food borne illness is vastly under reported. [The last government figures we saw indicated approximately 8 times under reporting for some illnesses]. Other experts believe that this is far greater. Whilst we appreciate ID studies they only tell part of a picture.

Since we have been dealing with the Agency since 2000 they have been unable to tell the charity scientifically which food products in relation to the bacterium E.coli 157 cause the most number of cases, therefore one would have thought that the precautionary approach should be taken in relation to raw or not thoroughly cooked type products, as scientifically we do know what bacterium they may contain.

Given the risks involved, we do not consider that increased point of sale information to the consumer of these risks is an acceptable response. Rather we consider that this represents an abdication of responsibility of the FSA in protecting the public from the unacceptable risks posed by E.coli O157. Nonetheless, if the FSA were to go down this route, we consider that the risk should be properly explained to allow an informed choice to be made. Therefore, every menu where burgers are not cooked to the recommended temperature, the type of bacterium that may be present (e.g. E.coli O157, Listeria, Salmonella, etc.) should be set out. This should be in a large bold clearly visible font such as Aerial 14/16 and it should also set out the range of possible health problems (including kidney failure, neurological damage and even death) and identify those at particular risk (including the old, the young, pregnant women and the immune-compromised).

We would make what we consider to be the obvious point that those ordering the meals are not always the ones eating the particular food. Therefore if a family of four (mum, dad and two kids) eat at a Gourmet Burger restaurant and a parent orders all the burgers to be cooked rare, notwithstanding any labelling, then it is the children that exposed to the increased risk of E.coli O157.

In the FSA Annual Scientific report for 2013/2014 it states, “The FSA exists to protect public health and the interests of consumers in relation to food. Our pledge is to put consumers first in everything we do”. We would urge you to do so.

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