Human Milk Purchased Over the Internet May be Contaminated

Previously I talked about how a shortage of human milk has led some mothers to purchase human milk from sellers who advertise over the Internet (see "Buying Human Milk for Your Baby"). I pointed out that while milk obtained from milk banks affiliated with the Human Milk Banking Association of North America (HMBANA) is always pasteurized before it is distributed, unpasteurized human milk from unregulated Internet sites or from unscreened donors might pose a health risk to the infant. At the time, there was no evidence to support or deny the latter assertion.

Now there is. In a study just published in Pediatrics, researchers from Ohio State University ordered samples of human milk from individual sellers who advertised human milk for sale on two of the major Internet sites for milk sharing. For comparison, they also obtained samples of unpasteurized human milk donated to an HMBANA-affiliated milk bank. All samples were tested for bacteria and several viruses (HIV-1 and cytomegalovirus). 74% of the Internet milk samples (and 35% of the unpasteurized milk bank samples) were contaminated with pathogenic bacteria. No samples from either source were HIV-positive, but 21% of Internet samples and 5% of the milk bank samples contained evidence of cytomegalovirus contamination. In general, samples obtained over the Internet also contained higher mean bacterial counts than the milk bank samples.

The study clearly points out the potential risks involved in accepting unpasteurized human milk from unscreened donors who advertise over the Internet. Human milk banks affiliated with the HMBABA pasteurize all milk before it is distributed. In addition, the milk banks screen their donors carefully and instruct them in the proper shipping guidelines (milk is to be frozen, delivered overnight). In contrast, there was wide variability in how milk obtained from individual sellers over the Internet was shipped; over 10% of the milk samples took more than three days to arrive.

How many infants are put “at risk for negative outcomes”, as the authors so elegantly put it, by human milk purchased over the Internet is probably unknowable. Again, I say “buyer beware”.

Note: only the abstract of the research article is available for free; the full article is available for $12. I’d like to see all scientific research articles supported by grant funds available free of charge.

What Do Food “Sell By” Dates Mean?

Do you check the “sell by” dates of foods in the grocery store, avoiding anything that is past its “sell by” date?  Do you toss food items out of the refrigerator once the “sell by” date is passed?   If so, you’re not alone.   For many, it’s a perceived issue of food safety.   A commonly held belief is that those “sell by” dates are a legal requirement, determined by some federal government agency (the FDA?) to protect us from contaminated food.

In fact, food “sell by” and “best if used by” dates are not determined by the FDA, or by any other federal agency for that matter.  They are simply estimates by the food's manufacturer of when the food passes some arbitrary measure of quality, such as taste, texture, or nutritiousness.  After all, they don't want you buying their product and then not being happy with it.  Retail stores are not required to remove food items from their shelves once the “sell by” date is passed.  However, in order to maintain good customer relations many stores do discard them, or at least mark them down for quick sale.  Some states require that certain food products have "sell by" dates, others don't.

The bottom line is that "sell by" dates are not designed to protect us from tainted food.  That would be next to impossible, because how a food product is stored and handled after it is produced (storage temperature, humidity, etc.) has a major role in how long it takes to spoil.

Granted, it’s hard to tell when a food actually has gone bad.  Those “sell by” dates can certainly be an important clue.  But in the final analysis, you the consumer are left to use your best judgment.   Buy foods with the best “sell by” dates that you can, and be aware of how they have been stored in your home.   If they’re supposed to be refrigerated, were they kept cold in transit?  What’s the temperature in your refrigerator?   Finally, use your senses.  If it’s got mold on it and smells or tastes a bit off (or is way past it’s “best if used by” date) throw it away.

For an in-depth look at this subject, see "The Dating Game: How Confusing Food Date Labels Lead to Food Waste in America", a joint project of Harvard Food Law and Policy Clinic and the Natural Resources Defense Council. 

Are Teens Getting Healthier? Maybe, Maybe Not

The prevalence of obesity in the U.S. has been rising for about as long as anyone can remember. Nevertheless, there are some indications that obesity prevalence may be stabilizing.

How (or if) changing trends in adolescent behavior could be contributing to this stabilization is not known. To find out, researchers examined some key variables related to diet and exercise among adolescents in grades 6-10 over an eight-year period. Their study, published recently in Pediatrics, shows that over the eight-year period there were significant increases in exercise (number of days with at least 60 minutes of physical activity) and consumption of fruits and vegetables. Television viewing and consumption of sweets and sweetened beverages both decreased.

Despite these slight improvements in diet and exercise, body mass index (BMI - a crude measure of obesity) continued to trend upward in adolescents. Nevertheless, the results are considered encouraging by public health officials, in that public education efforts to get kids to exercise more and eat a healthy diet may actually be working.

The decrease in television viewing may just be a reflection of changing tends in technology use. Significantly, adolescents continue to spend a lot of time on video games and on computer use (including chatting, internet, e-mail, social networking, etc.). Video games and computer use (assessed only over the last four years of the study) did not decrease over time; together, they now account for nearly two hours per day among this age group.

New Regulation Proposed for Compounding Pharmacies

A bill is currently making its way through Congress that could potentially give the F.D.A. more power to regulate compounding pharmacies. Traditionally, compounding pharmacies have not been regulated by the F.D.A. because they do not manufacture drugs, as pharmaceutical companies do – they only recombine drugs into specific combinations at the request of hospitals and physicians. Currently, compounding pharmacies are regulated solely by states’ pharmacy boards, even though they may ship their products across state lines.

But then last year a Massachusetts-based compounding pharmacy accidentally made contaminated batches of drugs. The result was more than 700 cases of spinal infections, including meningitis. Sixty-four people from 9 different states died.

The new law would give the F.D.A. much of the same power over the compounding pharmacies that it has over drug manufacturers. The F.D.A. would be able to review the companies’ records and inspect their facilities. In addition, the compounding pharmacy would have to alert the F.D.A. when something goes wrong. However, there’s a big catch; F.D.A. regulation would be voluntary. According to the specific language in the proposed bill, F.D.A. regulation would be available to compounding pharmacies “who wish” to be regulated.

Seriously? Supporters of the bill defend the voluntary nature of the proposed regulation by saying that the market will drive demand, because hospitals and doctors will choose to do business only with compounding pharmacies that are “F.D.A.-regulated”. Maybe, but price often trumps all other considerations. And you, the consumer, will never know where your doctor or hospital gets its compounded drugs.

This is a weak attempt to fix a serious problem. Why not just go all the way and require that all compounding pharmacies be regulated by the F.D.A.?

Running or Walking Decrease the Risk of Osteoarthritis

Several years ago a longitudinal study of 45 runners and 53 controls (non-runners) over an 18-year period reported that running does not lead to increased incidence of osteoarthritis later in life (see "Is Running Hard on Knees?").

Now, a much larger study shows that running or even just walking may actually reduce the risk of degenerative diseases such as osteoarthritis. The study examined the number of reported cases of osteoarthritis and hip replacements in over 70,000 runners, as well as walkers and persons who engaged in other exercises of equivalent energy expenditure, over a seven-year period. The authors report that the runners and walkers had fewer reported cases of osteoarthritis and fewer hip replacement surgeries than non-runners who engage in equivalent energy-expenditure exercises.

The decreased risk of osteoarthritis in runners and walkers was strongly associated with the lower BMIs (body mass index) of the runners and walkers. In other words, it may not be the running or walking per se that reduces the osteoarthritis risk. Instead, it may be that running and walking are just very effective ways to keep the weight off, putting less strain on hips and knees.

First Official Report on Deaths from Antibiotic-resistant Bacteria

The CDC has issued its first official report on the threat posed by antibiotic-resistant disease organisms. The report shows that over 2 million Americans develop antibiotic-resistant bacterial infections each year, and that over 23,000 people die as a result of those infections.

The number of deaths is actually a bit lower than previous unofficial estimates. That’s because the CDC deliberately took a conservative approach, including in its estimates only deaths that were a direct result of an antibiotic-resistant infection. Many more deaths were complicated by an antibiotic-resistant bacterial infection, but were not necessarily caused primarily by the infection. By including only deaths directly caused by such infections, the report will serve as an important baseline against which future changes in antibiotic resistance can be measured.

For some time now, health officials have been warning that over-use of antibiotics is encouraging the development of antibiotic resistance. Over 70% of antibiotic use in the U.S. is to prevent the development of infections in healthy animals that are at risk of infections because they are housed close together, such as cattle in feedlots. Many of the prescriptions for antibiotics written for humans are unnecessary as well. Antibiotics do not shorten the duration of a cold or the flu, for example, but people who are suffering from a cold or the flu still ask for them, and many doctors oblige.