Along with ketchup, pickles, and buns, backyard barbecuers should be armed with something else this grilling season: a meat thermometer. Experts say it's the only sure way to prevent a potential food poisoning disaster.
"The only safe hamburger is one cooked to 160 degrees," says Nancy Donley, president of the nonprofit Safe Tables Our Priority, a food-safety advocacy group. "Research has shown color is not a reliable indicator."
Donley learned about food safety in the hardest way possible. Seven years ago, her son Alex ate a contaminated hamburger and died. He was just 6. "I didn't have a clue -- I really didn't -- that food could be a carrier of bacteria," she says.
What killed Alex was infection with the bacterium E. coli. It can cause a severe complication called hemolytic uremic syndrome (HUS).
"HUS can come from other causes, but 75% of it is related to food poisoning; most of it to [E. coli]," says Edward Traceman, MD, who treated Alex Donley. "The problem isn't the bacteria itself, but the toxin released by the bacteria."
Traceman says HUS causes one main symptom in the body -- blood clots -- that leads to numerous complications, such as kidney failure. "You don't use antibiotics to treat it. What you try to do is clean the toxin from the body, by washing the blood, basically .... You try to weather the storm."
In fact, a study by researchers at the University of Washington School of Medicine in Seattle indicated that, in children infected with E. coli, antibiotics could actually bring on HUS.
Most patients shake off E. coli poisoning within six weeks, Traceman says, but about 5% never do.
What worries Donley is that the E. coli situation may not have improved much, despite a number of well-publicized cases, including a 1993 outbreak linked to undercooked burgers from Jack in the Box restaurants and a spate of 1996 cases linked to Odwalla brand fruit juice.
The good news is that cases of food-borne bacterial illnesses have dropped 23% since 1996, according to the CDC. The four major bacterial food-borne illnesses -- campylobacter, salmonella, listeria, and E. coli -- dropped 21% in the past six years. Campylobacter infections dropped 27%, infections from listeria fell 35%, and salmonella infections decreased by 15%. E. coli infections dropped 21%, but all of that decline occurred since 2000.
Donley says that about half the cattle that come in for slaughter have some exposure to E. coli, and that ground meat samples tested by the federal government are turning up higher amounts of bacteria than before -- although this may be because of better testing.
"The slaughterhouse market is relatively unchanged since Sinclair Lewis wrote The Jungle," says Bill Marler, a Seattle attorney who has represented victims of some of the most notorious food poisoning cases of the last decade, including the Jack in the Box and Odwalla cases. He holds this opinion despite the fact that some plants have adopted new Hazard Analysis Critical Control Point (HACCP) quality-control procedures to keep contamination down.
"The concept is great," Marler says. "You look at those particular areas with the potential for contamination and focus on it and deal with it. In reality, it still takes a commitment by the company." Still, he adds, "I think you have got to have oversight in addition to HACCP. You can't let your own industry regulate itself."
But others say the U.S. food supply has gotten safer. "I think we've come a long way, in part because of educational initiatives, educating the public, and steps the government has taken," says Kathleen Zellman, RD, a spokeswoman for the American Dietetic Association. "We're safer than we were a year ago; we're safer than we were five years ago. ... The federal government is doing the job to keep the food supply safe."
The nation's slaughterhouses have done a good job driving down levels of salmonella, one food safety expert says, but there isn't enough evidence to show the same is true for E. coli.
Mike Doyle, PhD, director of the University of Georgia's Center for Food Safety and Quality Enhancement, in Griffin, says some facilities are now steam-cleaning carcasses during processing to help get rid of contamination, but that cows almost invariably come into the plant dirty. "The hooker is, we're not going to be eliminating everything," he says.
And that's where the consumer comes in. Proper cooking is of key importance, but it's not the only thing. Raw meat should be handled very carefully, all the way from the grocery story to the plate. "One of the problems we have when you're talking about grilling is, consumers will cook the hamburger well and then put it back on the plate with the [raw] contaminated juices," Doyle says.
Dietitian Chris Rosenbloom, PhD, RD, says other careless practices include serving the same batch of marinade used on raw meat as a sauce for the final product, using a dirty grill, and guessing at the meat's internal temperature: "People think, 'Oh well, I can look at the color of the meat'" to see if it's done, Rosenbloom says. "I think you can get into trouble that way."
Another way to get into trouble is letting anything that's supposed to be refrigerated sit out for longer than two hours. Rosenbloom, an associate professor of nutrition at Georgia State University, in Atlanta, says it's also a good idea to split deep-dish casseroles into smaller portions before refrigerating them. That way, they'll cool down faster.
But refrigeration is no guarantee of anything when it comes to food poisoning. Consider listeria, a bacterium that thrives in cold conditions. It can cause pregnant women to miscarry and others to develop meningitis, an infection of the tissues surrounding the brain and spinal cord.
"It's darn near impossible to eliminate," Doyle says, though he adds that food processors are trying, by adding growth inhibitors to products, for one thing. "The food industry in general has gone to great strides to reduce listeria. The problem we have is the organism is so widespread."
It becomes especially widespread in certain types of foods, Doyle says, such as processed meats and soft cheeses, even when they're within their shelf life. Cooking destroys listeria, but the problem is that many of the foods in which it can most readily multiply don't always get further cooking. One of these foods is hot dogs. "They need to be cooked," Zellman says -- period.
E. coli gets most of the press, with salmonella not far behind. But neither leads the list, as far as causing food poisoning in the United States. That honor goes to campylobacter, which the CDC estimates may cause up to 4 million cases a year of food poisoning -- with nausea, vomiting, and diarrhea the most likely symptoms.
Less common is a long-term complication from campylobacter infection: the development of Guillain-Barre syndrome, in which the body begins to attack some of its own nerves, with weakness and paralysis resulting.
The most common place to find campylobacter? Raw chicken. Cook it to 180 degrees on the meat thermometer, the experts say, and it's safe to eat.