Bad food: How doctors can zero in on foodborne illnesses

A new primer from the AMA and federal agencies helps physicians recognize, treat and report these sicknesses.

Editorial. Feb. 19, 2001.

Far and away, most of the food we eat in America is safe. That's a good thing, but it can hide something bad. When a foodborne illness does strike, very often the victim, and even that person's physician, won't make the connection immediately.

That can have serious, even deadly consequences, especially if there is a delay in recognizing and preventing a large-scale outbreak. About 5,000 Americans -- mostly the very young, very old or those with suppressed immune systems -- die each year of foodborne illnesses. An enormous number more -- the Centers for Disease Control and Prevention estimates 76 million cases annually -- become ill, although most get better soon with no lasting harm done. However, as many as 300,000 hospitalizations stem from foodborne illness annually.

For a copy

To help primary care physicians better recognize, treat and report foodborne illnesses, the AMA and three federal agencies -- the CDC, Food and Drug Administration and Dept. of Agriculture -- have created "Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians." It is timely reading.

Ironically, the fact that more Americans are eating healthier is another good thing with a sometimes harmful twist. A greater demand for fresh produce means that more fruits and vegetables are imported from overseas, including from countries with lax agricultural oversight, allowing contaminated food to slip by.

In other cases, it's not the food that has traveled across the globe -- it's the patient. More international travel creates more opportunities to bring a novel strain of food poisoning back home. Meanwhile, in this country it has been amply demonstrated that the food supply is not free of pathogens such as Listeria, E. coli and Salmonella that can cause major outbreaks.

The first goal of the primer is appropriate diagnosis and patient care. Medical schools and residency programs generally don't have specific curricula for foodborne illnesses. The primer helps fill the gaps with up-to-date information.

The second goal is a recognition that physicians are a key line of defense in spotting major outbreaks that can affect hundreds and be deadly for high-risk individuals.

Labs will often report to the local board of health when a stool sample tests positive. But so can the doctor, and it requires a physician to order the test in the first place. Not enough of that testing and reporting is now being done. With a food supply not quite as safe as we think it is, many thousands of Americans suffer needlessly.

ADDITIONAL INFORMATION:

For a copy

To obtain a copy of the primer, contact the AMA by phone at (312) 464-4147 or by e-mail (litjen_tan@ama-assn.org). It can also be downloaded from the AMA Web site (http://www.ama-assn.org/foodborne). The primer is a joint project of the AMA, the Centers for Disease Control and Prevention, the Food and Drug Administration's Center for Food Safety and Applied Nutrition, and the U.S. Dept. of Agriculture's Food Safety and Inspection Service.