One of the hallmarks of living in a high-income country is that we can usually take food safety for granted. But what happens when food contamination recalls are on the rise? Food contamination was a full-blown epidemic at the turn of the 20th century. Abdul reflects on how much behind-the-scenes work goes into keeping food safe. Then he interviews Deborah Blum, a science journalist and author of two books about the history of food safety about what the history of food safety regulation should teach us about the future.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: United Health Care, a nationwide health insurance provider, faces a class action lawsuit for using algorithms to deny health care to Medicare beneficiaries. Congenital syphilis is up more than 11 fold over the last decade. Hospitals are under siege in Gaza. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] As I literally sat down to tape this episode, I got an alert on one of the public health networks I’m a part of as a county public health official. It read, and I quote, “certain cinnamon applesauce puree pouches recalled due to high levels of lead.” Lead in apple sauce in the United States in 2023. We assume that the food we eat is safe and secure, that in the richest, most powerful country in the world, the stuff you put into your body won’t make you sick. But food recalls because of contaminants. Or the rocks in cookies or insects in broccoli and cheese soup is on the rise. And that should be really unsettling. After all, the Food and Drug Administration is 117 years old, and we’ve had laws on the books that should be protecting us from leaded cinnamon applesauce since then. But laws are only as good as their enforcement. And there are a whole bunch of reasons why enforcement has become such a challenge. First, we routinely underfund the FDA and agencies at the state and local level just like it, meaning they lack the resources to fully inspect all of the facilities under their purview. Instead, food manufacturers are left to self inspect and report their findings. What could go wrong? Worst still the food sector, like almost all of the economy is consolidating. That means that little companies are being gobbled up, contaminants and all by the big guys. Think about it. If you analyzed four out of five of the most common groceries, only four companies control the market for more than half of them. Along with market power, our porous firewall between politics and the economy means that those companies also have political power. Their campaign contributions and lobbying expenditures allow them to manipulate the kinds of laws that get passed and the kind of funding allocations that the agencies that enforce those laws have to enforce them. Collectively there’s been an erosion in the food regulatory space. And the consequences have meant more food recalls or worse, more food poisoning. But this isn’t the first time we’ve faced this kind of thing. In fact, there was a time in this country where it wasn’t simply that food regulations had eroded, but that there weren’t any food regulations at all. It was a time when food companies put formaldehyde, you know, the stuff we use to embalm dead bodies in milk to keep it from spoiling just a little longer. When dyed corn syrup passed as maple syrup and burnt wood passed as pepper. Don’t get me started on the meat. If you’re interested, go read Upton Sinclair’s The Jungle for a description of what slaughterhouses in that era looked like. It was the turn of the 20th century, and a team of scientists at the fledgling USDA was working to understand exactly what all the additives they found in America’s food supply could do. The science would never have passed an ethical review board. But the broader purpose of their inquiry was clear. To inform Americans about what they were eating, or probably more appropriately, what they were being fed. Leading the team was one doctor Harvey Wiley, a name that’s been lost to history, but a public health leader whose work led to the creation of the FDA in the first place. Hounded by the food industry and beloved by the public, his work back then could teach us a lot about what it should look like to protect our own food supply over a century later. I learned about Dr. Wiley from a couple of books by science journalist and author Deborah Blum. Her books, The Poisoner’s Handbook and the Poison Squad, tell the story of Dr. Wiley and his team and the audacity of the industry they took on. She joined me to explain what America’s food supply looked like in the late 1800s, how Wiley and his team worked to fix it, and what that should teach us today. Here’s my conversation with Deborah Blum. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Deborah Blum: Sure. Hi, I’m Deborah Blum. I’m the author of The Poison Squad and The Poisoner’s Handbook, and I work at MIT. 

Dr. Abdul El-Sayed: Well, we really appreciate you taking the time, because, you know, I um. I spent most of my career in public health thinking about all of the ways that uh that corporations can um sometimes corrupt the things that we uh would like to consume to make us healthy. And I really this is the first time I’ve come across what is a really, really rich history about a moment in time when a lot of the modern day regulatory infrastructure that we take for granted uh came to be. So I got to ask you, you know, what got you interested in writing about the history of poisonous chemicals in food uh and the way that that infrastructure came to be. 

Deborah Blum: That’s a great question. And I guess I have to start out by saying in a kind of creepy way that I’m very interested in poisons in our everyday life. And I’ve been tracking them as a toxicology journalist probably for almost 15 years now. And in the course of doing research, this is sort of backing into the story. I came across references to an experiment which was nicknamed the Poison Squad and which occurred in the early right at the turn of the 20th century. And if you look at that experiment, it involves a chemist, Harvey Washington Wiley, who was at the USDA, poisoning his coworkers. It’s literally an experiment in which he feeds poison to deliberately to young clerks at the Department of Agriculture trying to figure out what’s safe to our food supply. And I and I stopped at that moment and I said, well, why would you do that? Right. Why would you feel so desperate that the only way you could figure out to get at an issue was to deliberately feed poisons to people you worked with. And that led me backwards into the 19th century before we actually started regulating any poisonous chemicals. We had no regulations for drugs. We had no regulations for what in our foods. We had no regulations for medicine. The US government was completely hands off about what corporations did. And so I wanted to start there. What was it like before we had regulations? What were we actually eating and how safe was it out there? And that really got me on the journey, I think. 

Dr. Abdul El-Sayed: And so what was it like? I mean, I can imagine that that’s nuts. Um. We recently had an episode talking about the degree of of ultra processing that goes in foods, and it already feels kind of nuts. Walk us through what life would have been like at the turn of the 20th century in America without any of this regulatory apparatus, the FDA uh and a whole set of laws that enable it to be that made sure that when we pop something in our mouth, it is what it says it is. 

Deborah Blum: Or so we hope, right? So, yeah. So if you go back to the 19th century, there was no consumer protection whatsoever. I mean, that’s kind of an astonishing fact. But there was not a single federal law on the books about protecting consumers. And that meant that it was an open door for industry. 

Dr. Abdul El-Sayed: Wow. 

Deborah Blum: To do whatever they wanted with drink, food, drugs, the works. And they did, in fact, take advantage of that, especially for people who couldn’t afford to sort of buy higher quality things. So as an example, my story was really built about around this chemist, Harvey Wiley, who came to the USDA in 1883, and he just said, why don’t we take a look at what people are eating, Let’s look at the food supply. He and his chemist, and they’re a tiny division, right? Maybe a dozen chemists in the entire United States responsible for this at the federal level. They start picking apart the food supply. They look at dairy, they look at milk, they look at canned vegetables. They look at coffee and tea and wine and beer. And they find two things consistently. One, they find an insane amount of fraud in food. So if you were sprinkling cinnamon over your cinnamon toast, you were likely sprinkling brick dust. 

Dr. Abdul El-Sayed: Wow. 

Deborah Blum: Instead of, you know, peppering up they the chemist actually used to call this pepper rat, but they would use charred bone in pepper. They would use ground shells, they would grind up coconut shells, they would char rope, they would mix gypsum, you know, gypsum from wallboard uh in flour. They would fake coffee beans with wax and dirt. Right. That there’s just an insane amount of fraud across the food supply. And then the other part of that is there’s a really dismaying amount of toxic chemicals going into the food supply. So part of it is just crazy fake. All of that is legal and part of it is crazy dangerous. And probably my favorite example of crazy dangerous is milk. I mean, milk was dangerous anyway because we didn’t pasteurize and there was no refrigeration, you know, especially in a time there were a lot of people, people didn’t have electricity, but so milk would rot. And to counter that, the American dairy man would put formaldehyde in the milk. 

Dr. Abdul El-Sayed: Wow. 

Deborah Blum: And so, yeah, and so if you actually look at newspapers of the 19th century, you can find what they called embalmed milk scandals. In which children are dying because there’s so much formaldehyde in the milk. I mean, there was kind of there were no standards. There were no safety standards. There were no labels. Right. Aside from anything else, you never knew what was in your food so they could put formaldehyde in the milk without telling anyone. And you just get people saying, hey, if a little goes a long way a lot, right? And then one summer, I think it was 1898, in Indianapolis, 400 children died of formaldehyde poisoning and it was 100% legal. No one was proces– right. So that’s really what it was like. And that’s where you start to see Harvey Wiley and some of his allies, especially state food chemists, starting to say this has got to stop. We have got to figure out a way to convince Congress to regulate this. Right. People are dying. The food supply is incredibly unsafe. And he as part of that, he launches this series of experiments. Formaldehyde was one of the things they tested. Borax, which you see in the cleaning supplies now, 20 [?] Borax, right. Salicylic acid, which is the compound in aspirin that makes the lining of your stomach bleed. He’s looking at all of these different things which are in the food supply and he’s testing them in this very this you know, it’s a very primitive but fairly controlled experiment in which they’re adding it to food. Right? And comparing the young clerical workers who are eating the food with the contaminants to ones who are just eating untainted food and looking at what happened. 

Dr. Abdul El-Sayed: So I want to step back, you know, who who was Harvey Wiley? Clearly, he’s a chemist in a moment where the food supply is just incredibly dangerous and companies are getting away with literally murder. 

Deborah Blum: Yes. 

Dr. Abdul El-Sayed: And this is a chemist who realizes that this is a moment for science and action. Who is he before he he comes to public light, he becomes this sort of, you know, public service hero? 

Deborah Blum: Yeah, that’s a wonderful question. And I tend to be drawn to really complicated, difficult people. So it’s fair to say he was partly that, but I always think of him as a holy roller of a chemist, right? His father was a itinerant preacher and a conductor on the Underground Railroad in Indiana where he grew up. He uh you’ll hear him talking a lot when he gives speeches about the importance of science in the interest of good. And so when he went into chemistry at in Indiana, which was where he was from, he he really was focused on this missionary sense of science that had to do good in the world. And so he was the first professor of chemistry at Purdue University when they had a faculty of six. So I mean, this is very early on in the history of the university. And while he was there, he started investigating fraud in the food supply. He was looking particularly at honey and syrup. They were starting to fake maple sirup with co– dye as dyed corn syrup and calling it maple syrup. And they were so elaborate in their corn syrup, honey frauds, they actually created fake honeycombs and floated them in the, you know, dyed corn syrup. So that was one of the first reports he did in Indiana. And that work brought him attention of this tiny Bureau of Chemistry at the national level. And so when he went to USDA in 1883, sort of the pump was already primed with him. He already had a sense that there was dishonesty and he had this missionary sense that he was there to actually try to do good. And and he was a total consumer first kind of warrior. Right. So and as you see him as he starts to discover more and more dangerous things in food and beyond the things I was telling you about, you know, arsenic was used to color candy green, lead was used to make cheddar cheese more orange. There’s just this insane use of poisonous things in the food supply. He gets more and more determined that he has to make this change and he becomes more and more of an advocate. And he makes a lot of enemies along the way. But he does eventually become part of a successful push. He wasn’t the only hero here um in getting us our first consumer protection regulations. 

Dr. Abdul El-Sayed: Before we get there. I want to ask, you know, so so this is this is a guy who realizes that he’s got to do something, but it’s also the 1880s. And the idea of IRB did was was 70 years in the making or 60 some years in the making. Uh. And he’s got a group of people he’s literally testing some of these these poisons on, what does that look like? And you know, you know on the one hand this is a great good for the public and on the other, like one one starts to appreciate why we have very rigorous scientific ethics these days. How did that go down? 

Deborah Blum: Yes, yes so you could never do that experiment today. Even when you read it and you put it in full context, it’s like, oh, this is so bad at some level because people got really sick. So basically, here’s what he did. He brought in, I want to say, you know, in numbers, there were probably a couple of dozen young men who went through this experiment and in this very Victorian era kind of way. He picked only young athletic college aged men for this experiment. And he picked them because he knew there was some risk involved. So he thought, I’ll get the strongest, healthiest specimens, thinking in the terms of the day that I can. And if they’re affected by these compounds, then think of the risks to children or sick people or elderly people, but also they’re less likely to die. Even so, he had them sign a waiver, right. Acknowledging that they were at risk. I truthfully you know, the other thing we do I hope better today is sort of full disclosure of risk when we put people into experiments, and I don’t think these guys knew how dangerous it was. Right. So the first experiment he did, this is what what happened. They built a model test kitchen in the basement of the Agriculture Department. They built a dining room with white tablecloths and oak chairs. Right. They would seat a dozen of these young men at one of two tables, basically. And and all the food was wonderful. They hired a professional chef. It was farm, fresh food. No preservatives in the food. Right. Just fabulous, wonderful food. But they could only eat in the the USDA dining room, and half of them had to take these capsules in which he had put these different compounds. And as the week went on or the two weeks of the experiment, the he increased the dose in the capsules. So the first experiment was with Borax. And he actually said he thought that it was harmless when he started testing it because and this is the other thing, when I was doing the research for this book, I keep going, where are these studies? Right. And just public health is so primitive at this time. Toxicology is so early at this time. The toxicology that existed mostly focused on homicide. They weren’t even thinking about food, right? 

Dr. Abdul El-Sayed: Wow. 

Deborah Blum: So there are no real experiments there you’ll see there was a guy at the University of Pennsylvania who put a little formaldehyde in his milk one day to see how he felt. Those were the kind of experiments that were out there. 

Dr. Abdul El-Sayed: My God. 

Deborah Blum: So one of the things Wiley was trying to do in this very primitive way was to have you know a group and a control group, right? Have some bigger numbers to it, make it more systematic. All of these guys had to be blood tested and weighed and urinalysis and every possible analysis. Right. And so he’s trying to create what looks to him like a professional experiment. I mean, aside from the fact that, you know, there’s not really informed consent here and these are dangerous, untested compounds that he’s giving to people. Um. People got really sick. They had to call the formaldehyde experiment, even though my personal opinion, everyone knew formaldehyde was terrible. I mean, children have been dying, they they got their testees became so sick they just had to call off the whole experience. Right. But none of them died in the course of the experiment. Right. So you have to give them credit for at least picking sturdy people. 

Dr. Abdul El-Sayed: Well, that’s that’s something. Uh. [laughing] But, you know, this was this was a place in time where scientific ethics were very different. And, you know, certainly you can’t question the broader intentions of why he was trying to understand this because there were uh companies literally putting this, you know, in infants milk and uh and poisoning the public. And so being able to demonstrate to prove what the consequences uh of these kinds of chemicals could be was critical. I want to ask you, you know, what was the public’s response when he came out with these reports? Um. What uh what were the implications uh here once this happened? 

Deborah Blum: I think these had a profound public effect when they were reported and they were, you know, sort of rigorously followed by newspapers. I mean, at the time, the media was newspapers, right? Um. And part of it was that The Washington Post, this is right in The Washington Post’s backyard had fallen in love with these experiments. Wiley actually called them the hygienic table trials, very Victorian. The Post called them the poison squad, and they had one reporter who did nothing but tell these stories and work around the dining room and grilled the chef behind Wiley’s back and make this whole sort of dramatic telling. It ends up in newspapers coast to coast and I think for the first time and and I think this in part because when you look at the newspaper coverage coast to coast, every single newspaper is saying these people were eating poison. Right. These were all and they’re saying poison is part of your daily diet. And they would tell the kinds of things that these things were in right? Formaldehyde in milk, borax in butter, salicylic acid in your beer and your wine, you are getting poisoned on a daily basis. And so you start to get at this period but I think he started these in about 1902 and they ran and all till about for a couple of years. This sort of simmering public anger as they realize that everyone’s getting systematically poisoned and they can’t protect themselves because there is no available information as to how much is going into their food and when. There was a great deal of public reaction to to the the stories of these poison quads, squad studies. 

Dr. Abdul El-Sayed: And what was the industry’s response? 

Deborah Blum: The industry’s response was to disrupt, try to destroy Wiley’s career primarily. Right. And they actually ended up successfully planting people in the Department of Agriculture um and at one point actually creating a fake scandal to try to tarnish his reputation. And the um Borax Company of California actually hired people to plant fake news stories about Wiley and what a fraudulent scientist he was. Right? I mean, there it was in their best interest to make him look as bad as possible. And they and that was their primary reaction. Right. Was just to try to destroy his reputation and to damage his standing in the U.S. government. It was pretty ugly, actually. 

Dr. Abdul El-Sayed: Wow. And it seems it seems like a lot has changed, but a lot’s stayed the same. Um. So all of this leads to some really, really successful legislation. Uh. And in 1906, President Teddy Roosevelt signs what was then called the Wiley Act, um ultimately establishing uh the Food and Drug Administration that continues on today. What what was um some of the regulatory change that that that that came in the form of the Wiley Act?

Deborah Blum: Well, some compounds like formaldehyde were just outright banned. Right. I mean, they looked at the things that were clearly off the charts dangerous, and they got rid of them um and they worked on setting up actual safety standards. How much are we going to allow of this compound and how are we going to define things as toxic as not? I will say that there were so much industry opposition to the 1906 Food and Drug Act, the Wiley Act, that it was not a perfect law. You know, it had some really cumbersome problems in it, which is why in 1938 we ended up getting an update the 1938 Food, Drug and Cosmetics Act. But and one of the things about that law is that if you were going to try to force a company to withdraw a compound, you had to sue them in court. Right. And so and the burden of proof was on the government. And there still wasn’t complete requirement for the companies to do safety testing. Right. The government had to do the safety testing. So the law was both a first step. Let me say this about that law, because I think it’s really important that law was an absolutely essential first step in consumer protections in the United States. It was the first time in American history that the U.S. government had said part of our job is to protect consumers in their everyday life. I sometimes think of it as that clause in the Constitution, promote the general welfare. It was the first time that the government said and what does that mean? It means we take care of you when you’re just trying to live your life right? Eat a nontoxic breakfast. Right. Drink some non poison beer or whatever. Um. And that’s actually our job. Our job is to look out for you. That protecting American citizens is more than, you know, arming our borders essentially. And and that precedent, the precedent established by that law and a law that was went into law with the Meat Inspection Act, um those lay down the precedent for every consumer protection agency that follows the EPA, OSHA. Right. The FDA itself, all of them are based on the precedent of that law. So imperfect as it was, it changed the story. [music break]

Dr. Abdul El-Sayed, narrating: We’ll be back with more of my conversation with Deborah Blum after this break. [music break]. 

[AD BREAK] [music break]

Dr. Abdul El-Sayed: Obviously, there’s been so much effort put into consumer protection, although, you know, a lot of folks, including myself, would argue probably not enough. Can you can you tell us a little bit about um, you know, fast forwarding almost a century from the passage of of or more than a century, from the passage of that law to the present? Um. What would you say about about the current uh the current system of regulation that governs and protects us from being poisoned in in our daily lives? 

Deborah Blum: I mean, I will say first that we’re a lot better off than they were in the 19th century. And if we just look at food and you talk to medical historians, they’ll tell you that in the 19th century, food was one of the top ten causes of death. We know that’s not true today. Right. Food is not one of the top ten causes of death. But if you actually look at the number of people who die of something like food poisoning, it’s about 3000 people a year, according to CDC statistics. If you actually look at the number of people get sick, however, it starts to be in the tens or even hundreds of thousands. And that tells you that the system is better but it is far from perfect. So if I was going to pick a couple of things that I would like to hammer on, hammer, you know, sort of, you know, argue for, for one that we have some much more modern, decent rules that we don’t really enforce well, right? And our enforcement of those laws went backwards somewhat in the Trump administration as an example, with food. Under Obama, they passed the Food Safety Modernization Act to really start using much more current technology and start looking at contaminants at, you know, a part per billion level and figure out where the sources of contamination came from and look at things like contamination of the kind of water used to, it with crops. All of that rolled back during the Trump administration and all of that is being gradually restored. But when you start to see things like romaine lettuce recalls. Right. And you really look at what’s going on there, you can see that some of the problems we have today with those kind of food poisoning episodes have to do with the fact that we’re not fully enforcing the laws we have. Right. And we’re not really funding them well. And that’s the other problem. We have a pretty good regulatory apparatus in place that we just don’t put enough money into. Um. So the FDA, for instance, gets, I think, about a billion a year for food inspection of pretty close to 100,000 facilities. Right. Um. And some of those facilities, as I remember from the last time I talked to someone about this, sometimes on their rotation, they only have enough people or enough money to inspect every several years. Right. So obviously, that too is not working in our favor. And finally, you know, do we see companies? Let me back up one more minute really quickly. You know, I pretty much hammered the food industry of the early 20th century. There were some exceptions. There were um the Cannery Group, which was really worried that people were no longer buying canned goods in part. Right? Really came forward for the Food Act and some of the big manufacturers. Um. Henry J. Heinz is the most famous of the manufacturers who really came forward and advocated for you know better food and safety standards. So I don’t want to just say everyone was a bad actor because that wasn’t true. And I don’t want to say that entire today either. Right. Not everyone is a bad actor, but I’ve given a lot of talks at the FDA. I know there’s a lot of industry and political pressure on the FDA. Right. So I and I think that shows in a lot of regulatory actions as well, that government industry handshake that we saw behind our backs in Wiley’s time is just as strong today. Right. I don’t have a doubt about that. 

Dr. Abdul El-Sayed: Yeah, I really appreciate you raising that, because one of the ways in which you get a de facto bypassing of regulatory legislation intended for the public good is that you end up having regulatory regimes where the enforcement is outsourced to the companies themselves. And you can require that kind of thing. But what happens is there is there’s two things. They start testing on their own. And if they know they’re not going to get validated by the actual government regulator, um they start to whittle down what actually gets done. And then what happens is even if they’re not even if they’re not uh meeting their requirements, rarely is there a situation where they’re actually going to get shut down. So what happens is you end up having this like ratcheting down of the actual regulations because of the poor enforcement uh by the agency. You see this in the environmental space. You see this in the public health space, um and certainly you see it in the FDA. And then the second piece that you talked about is just that there’s been so much growth in industry, right? At least at that time uh a lot of the market share in food products was smaller mom and pop shops. Today–

Deborah Blum: Right. 

Dr. Abdul El-Sayed: Right. You have a few like mega, major, gigantic corporations that have consolidated their space. You know, we talked a lot, a lot about this uh last year when it came to inflation in the price of meat, for example, because you only have a few meat packing corporations who still do this and they do this on monstrous scales. And so if any one of these corporations were to actually get cited, they’ve got so much power through the way that they can invest in our um elections process that and they’re all giving to committee chairs uh for um the relevant committees that they’re worried about regulating them. And so you, like you said, there ends up being this sort of handshake deal and we don’t really pay as much attention to it in you know in this country. We’ve taken for granted that there was regulatory oversight of the food uh that we eat for so long that, you know, we sometimes don’t appreciate the amount of erosion that sometimes um has taken place. And uh and I just you know, it’s worrisome because you’re right. Like we talk about e coli outbreaks and bagged lettuce. Right. Or contamination of a certain food product. And we all kind of look at that and be like, oh, well, that’s odd. But when it happens more and more and more, just like when, you know, the electricity goes out and you’re like, wait, why is this happening all the time now? Um. One has to step back and look at the system. And, you know, I want to ask you, like as as we think about where we’d like to see this go, um what are some of the things that that that you really think uh we need to be paying attention to and that ought to be done in the regulatory space to upgrade uh the degree to which that we can uh count on the safety of our our food? 

Deborah Blum: So I thought your use of the word erosion was a really powerful one because I think we do see that right. The sort of and or see it as a strong word where we don’t always see it because it’s happening behind our backs. So one of the things that I would think that we could do a whole lot better is transparency and more information. It’s not fair to expect consumers you know, people say, well be an informed consumer. I mean, there’s no way for any one of us to keep up with everything that’s going into the food supply, right? So we actually need clear and transparent information. We need labels to be a little less opaque. Right. And and this, again, is a good example of an industry government kind of handshake. Like if you see the term natural flavorings on a label, it doesn’t mean natural, right? These are–

Dr. Abdul El-Sayed: Yeah. 

Deborah Blum: –almost all synthetic chemicals. And some of the food advocacy groups have actually forced the FDA to withdraw a couple of these so-called natural flavorings because they’re suspected carcinogens. So we need the information that goes to the consumer to be much more transparent if we’re going to put all this weight on the consumers then let’s arm consumers. Right? I think that’s part of it. And the other thing that I want to bring up, because I so you’ve probably heard the the fact that if you look at food, drugs and cosmetics, there’s about a thousand compounds that are banned in the EU that are permitted here overall. Right. And the big difference there is that in the in the EU, they use a kind of protective precautionary principle that, you know, studies show that this is dangerous and until we can prove it’s safe, we’re going to pull it right. Whereas here we use something. I think it’s actually on the FDA website called generally recognized as safe, the GRAS Principle. And it says something like this and I just saw this come up recently, titanium dioxide, you know, which is a compound in sunscreens, for instance, um and a white [?] paint is also in a lot of candy and food. And because it has never killed people by having it in paint, it’s generally recognized as safe. And it’s accepted that food companies can put titanium dioxide into the food supply, even though there are studies that show this is really a risky thing to do. Right? So that principle and that principle, again, was hammered out as a kind of convenience to industry, right? Instead of forcing you to test all of these things, the American people become the guinea pig. It’s generally recognized as safe until we actually start seeing problems. And I’m trying to remember it’s uh it’s brominated hydrogenated brominated brominated compounds in bread that are banned in the EU and permitted here. The FDA is just now starting to say, oh yeah, you know, those really are suspected carcinogens and maybe we should pull them, right? So I would also advocate not entirely optimisticly between you and me and the room. I would advocate that we should take another look at the generally recognized as safe principle. Right. That we should adopt more of a rigorous there’s a lot of evidence that shows this is risky. Let’s ban it until we can it’s proven safe kind of approach that they use in the EU. I think we’d be safer. 

Dr. Abdul El-Sayed: Yeah, I I agree. And it’s kind of nuts. I mean, when you think about it, right, the assumption that something is going to be safe until proven otherwise implies that the only way we identify something as being unsafe is it if many people get sick. [laugh]

Deborah Blum: That’s right. 

Dr. Abdul El-Sayed: And so what we’re basically saying is like there’s going to be a whole lot of illness and possibly death before there’s any real action to take this on. And, you know, in some respects, it’s just a reminder that the more things change, the more they stay the same. Um. And, you know, that’s that’s a that’s a it’s not it’s not something we need to do or should be doing. But for the system of politics, that leaves us biasing the interests of a corporate bottom line over the well-being of people who live in our country. And, you know, you see it across the board. 

Deborah Blum: Yes. 

Dr. Abdul El-Sayed: Industry by industry, by industry. And this is just kind of how it shows up in in food. And um, you know, it’s a pretty scary thing to think that you buy a product, you really don’t have any clue of what’s in it. I mean, all of us, you know, I have a PhD and a medical degree, and I’ll be honest with you, like when I get down to the bottom of an ingredients list, there’s a lot of stuff I don’t know about and would have to spend some time looking up. Now I have access and know where to go to figure out some of the toxicological findings. But you know, if you’re somebody who didn’t spend as much time in school as I did, that’s a difficult thing to do. And so we could tell people they should be informed consumers all day long. But what does that even mean? Um. And particularly when you’re thinking about foods that you like, feed your kids. 

Deborah Blum: We are totally one on that. And I usually when I go out and talk to people, I say and I’m thinking low dose toxicology here. I said, just mix it up right? Don’t eat the same thing every day to the best of your ability, right? Then you’re not going to get a continued exposure of one particular thing. Having said that, as I don’t practice it, I drink coffee every day, right. And and other things. So it sounds good, but it’s really hard to do that. I agree with you. I think, you know, we’re asking way too much of consumers without giving them access to the kind of information that they can use to make healthy, intelligent choices. And I’m disappointed about it on those grounds. 

Dr. Abdul El-Sayed: And to your point, Deborah, you know, the ability to eat a diversity of foodstuffs is a privilege. And for the lowest income people, the most marginalized people in our country, they don’t necessarily have the means to do that. Right. You think about what you can afford. Um. You know, I even think about, you know, less uh less, less moments where I was more challenged for resources in my life. You know, I, I, I shudder to think how much canned tuna I ate. Um. But, you know, these, these are choices. If you can make them, you should make. But, you know, for so many people in our country, those are not choices that they can make. And, you know, when when uh we allow industry particularly. Right for the cheapest foods, I mean, this is the thing about it if you’re eating at Whole Foods, right, or buy buying buying your uh your um uh groceries at what my medical school professor used to call whole paycheck. Uh. 

Deborah Blum: Yes. 

Dr. Abdul El-Sayed: You know, you you are much less likely to be exposed to some of the things um that may find themselves in the cheapest versions of food. But the cheaper it is, the higher the probability that uh you’re talking about foods where less attention is paid uh to how wholesome it might be, and there’s a higher probability to you know add additives that may increase the volume to decrease the price. And um and so this like almost all the issues we talk about on this podcast, end up hitting the the lowest income people hardest. 

Deborah Blum: That is such a good point. And I when we started this conversation, you were talking about ultra processed foods. Again, you know, a lot of the older processed foods end up being really cheap foods, right? And so the and they’re not good for you in any way that we’ve been able to discover. And again, that’s targeting the lowest income people. And again, that was definitely true in Wiley’s time. You know, the worst of the fraud, the worst of the fakery went to people because that was all they could afford. Actually, it really ticks me off um and, you know, and and then finally, we and we do false advertising of the healthy quality of some of these foods. Right? Like people believe that they’re getting whole grains in products which are so processed that they actually aren’t, right? So could we do, are we better off than we were in the 19th century? 100% right? Could we do a whole lot better? 100% again? We could totally could and we should actually do that. 

Dr. Abdul El-Sayed: Yeah. You know, it’s it’s one of those things that, you know, too often here in this in our country, we pat ourselves on the back for how far we’ve come when there’s so much yet further to go that we could go and we just we just end up making choices not to. And one always has to ask, well like why? Why are we leaving so much more progress and opportunity to improve situations on the table? And in the end, it almost always comes down to some quarterly bottom line for some very large corporation and their ability to make sure that they um buy they buy themselves access to policy and policy makers. Uh. We really appreciate you you know sharing um insights on both our history and and our current situation and for your leadership. Our guest today was Deborah Blum. She is the director of the Knight Science Journalism Program at MIT. Uh. Her books include The Poisoner’s Handbook and Poison Squad, uh and um we encourage you to check them out and and check out her her Pulitzer Prize winning work um both in the past and hopefully again someday in the future. 

Deborah Blum: Thank you. And thank you just for a such a smart conversation. It’s been such a pleasure to be here. [music break]

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. United Health Care is one of America’s largest private health insurers and the largest Medicare Advantage insurer in the country. Medicare Advantage is a privatized version of Medicare, whereby a corporation is paid a beneficiary’s Medicare dollars with the opportunity to pocket what it doesn’t spend on their health care. Now, think about the incentives that sets up. Medicare Advantage Providers have an incentive to deny claims because, well, they get to keep the money they don’t spend. Now United Health Care is facing a class action lawsuit over the alleged use of an algorithm that the lawsuit says denied rehab claims for those beneficiaries. The allegations center around a program called NH predict, which you can’t make this up, had a 90% error rate. And the lawsuit alleges that per the findings of a stat news investigation, UnitedHealthCare pressured employees to use NH predict to predict a patient’s length of stay in rehab and to deny coverage for any stay longer than what NH predicts algorithm predicted. We’ll keep you posted. According to the CDC, over 3700 infants were born with congenital syphilis in 2022. That’s 11 times as many as a decade ago. Syphilis is a sexually transmitted infection that can go dormant, meaning lots of people who are infected don’t know that they have it. But even when it’s dormant, it can pass to infants, causing blindness, deafness, stillbirth or death. Which is why it’s routinely screened for and treated simply with a shot of Bicillin in pregnancy. But here’s the problem, 40% of cases of congenital syphilis occurred in pregnancies where there was no prenatal care. Another 20% of those who did get prenatal care never got screened. That highlights a profound disconnect that pregnant folks feel from the health care system. In large part owing to the fragmentation of our system, the ways that under-insured and low income patients can be treated as second class health care citizens. And the way that bias against those folks, disproportionately Black and Brown can show up in a clinical encounter. But beyond that, there’s just more syphilis these days than in the past. And that highlights a broader consequence of the disinvestment in public health. Just a few decades ago, there were armies of nurses who could contact trace any syphilis infection, identifying from whom that individual may have contracted it and who they could have given it to. The networks they identified were all offered treatment, stopping syphilis in its tracks. But we slashed public health funding over the past decade, and those teams are a shell of what they used to be. And during the pandemic, they were all focused on contact tracing another disease, Covid. Congenital syphilis is completely preventable because syphilis is completely treatable. Our failure to prevent and treat it, that’s an indictment on the way we’ve allowed our public health system to deteriorate. Over the past several weeks, Israel’s military has been laying siege to hospitals in Gaza. Al-Shifa Hospital is the largest in Gaza, where 700 patients, 400 health care workers and 3000 displaced people were subject to an Israeli raid last week. The hospital has been without ready access to clean water, fuel to operate sensitive medical equipment or reliable electricity. 

[clip of unknown news reporters] Hundreds of people who had been sheltering at Gaza’s largest hospital evacuated on foot. Dozens of critically ill people. Including a number of premature babies who cannot leave, will remain there with a handful of doctors and carers. 

Dr. Abdul El-Sayed, narrating: Israel argues that Hamas is using tunnels underneath the hospital to attack Israel, rendering the hospitals into human shields. Here’s the thing about it, International law is clear that hospitals and health care workers are not to be attacked. There are not exceptions to this rule. Here’s W.H.O. Secretary General Tedros Ghebreyesus. 

[clip of Tedros Ghebreyesus] We need attacks on health care to stop. The Geneva Conventions were adopted and ratified to establish what’s acceptable and what is not in conflict. Violating the neutrality of health care is not acceptable. 

Dr. Abdul El-Sayed: To date, the best available estimates suggest that over 11,000 people, nearly 5000 children, have died in Gaza. That’s a child every ten minutes, according to the W.H.O.. Anyone who’s ever worked in a busy hospital can tell you that the work is hard, it’s grueling, and it’s at times unceasing. But I don’t know many who’ve worked in a hospital in a war zone. I know fewer still who’ve worked in hospitals that have been the targets of active war themselves, simply for showing up to care for the sick and injured. I can’t imagine what it’s like to know that you’re there to save lives while others so clearly discount your own. The only way to stop this violence is to stop this violence. And that starts with an immediate cease fire. I’ll leave you with the words of Dr. Hammam Alloh, a physician at Al-Shifa Hospital. 

[clip of unspecified reporter] How will you keep your family safe? How will you survive? Do you think? 

[clip of Dr. Hammam Alloh] I don’t know if over the next minutes I will survive or not, because I know a lot of people who thought they were safe and they were just simply killed. So I can’t really answer you this question, but I have already tried to buy enough things and utensils to keep things going smoothly over the 2 or 3 days. I mean water and food. But after that, I don’t know how I could drink uh at least milk for my six month old child. I can’t a real answer for you with a question or a good answer for your question. 

[clip of unspecified reporter] Wow. Well, you gave a very real answer to the question. 

Dr. Abdul El-Sayed: Dr. Alloh was killed in an Israeli airstrike last week. America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, and me. Dr. Abdul El-Sayed, your host. This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.