Sanjay Gupta on Mad Cow disease

Fri, 01/09/2009 - 8:40pm — DCblogger

COOPER: So, Sanjay, the third case of mad cow in the United States, how concerned should someone at home be?

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Well, you know, the short answer is probably not concerned at all, really, Anderson.

It's -- it's kind of interesting. On one hand, we used to say, here in the United States, mad cow disease was a disease of other countries, didn't worry about it. But after December of 2003, we had three cases in three years now. So, I think people are -- their -- their guard is up, for sure.

But, as far as the basic idea of -- of worrying about what you eat, worrying about your meat, there really is no concern at all, because this animal could not and did not get into the food supply chain.

COOPER: How is mad cow disease transferred to humans, if at all?

GUPTA: Well, you know, what's interesting is that the -- this is a disease of prions. The -- it's not a virus; it's not a bacteria.

Mad cow disease is actually called by something known as a prion. And that actually exists mainly in the nervous system, either in the brain or the spinal cord.

So, you know, here in the United States, we don't typically eat that sort of food as part of the overall meat. But, in many countries, they do, or it's part of the feed that they feed to other animals. Since '97, we -- there has been a ban on that sort of feed, so that animals shouldn't eat that. And we, as humans, don't eat that either. So, it's really unlikely that we would get it at all.

COOPER: So, people eating meat should not be concerned?

GUPTA: No.

You know, eating regular meat, you're probably not going to come in contact with these prions, this -- this -- these disease-containing particles. And, if you cook it using a meat thermometer, it should kill off whatever infectious agents there are anyway, so, really, really very little concern. There has never been a case of the human form of mad cow disease, known as CJD -- there has never been a case of it in this country.

COOPER: How does someone know if they do have mad cow disease?

GUPTA: You know, that's the interesting thing, Anderson. It can be about 10 to 15 years before you would actually develop any symptoms from -- from the human form of mad cow disease.

So, it's really hard to go back and try and figure out where it came from. And you probably can't remember what you had for dinner last night, let alone 10 to 15 years ago. So, it would be very unusual.

But the same sort of symptoms occur in the humans. You could have some confusion. You could have some difficulties with walking, that sort of thing -- but a very, very rare disease, for sure.

COOPER: Well, this is a certainly blow to -- to the export of meat overseas. I know a lot of people are concerned about that. But, certainly, for people at home, good to hear that it really won't have much of an impact.

Sanjay, thanks.

GUPTA: Thank you.

This guy should not be surgeon general.

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Comments

Cooking destroys prions? Since when, Dear Doctor?

By jawbone on Fri, 01/09/2009 - 8:53pm

Am I wrong that not even surgical instrument heat sterilization kills prions? And nerve and spinal material never get into or onto the rest of the slaughtered and butchered animal?

Yikes--whenever he was near points which needed actual explication, he just fell back on cant and cliche. Is he reading some script, so that he won't make a mistake and give the audience actual information?

Oh, and those symptoms? LIke trouble walking and "some confusion"? Real accurate picture, there, eh, doctor? I don't think we know how awful a death it is for the patient, but it is horrible for those who watch the disease progression in someone who becomes "not there."

Didn't he watch any of the coverage of those British mad cow patients?

Of course, he did the job he was there to do, which was to make the public forget about the possibility of mad cow disease in the US food chain. That's why he got the big bucks.

And now the big nomination.

Got a link on that? I couldn't find one

By lambert on Fri, 01/09/2009 - 9:05pm

IIRC, the good doctor is dispensing lethal advice. A link would be goof, though.

(He also calls them "disease-carrying." That's a little bizarre, too.

I'm waiting for the remaining fact so I can write the headline "Why does Sanjay Gupta want you to go mad and die from eating deadly meat?" Or some such.

—

"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi

I googled for some articles--some scientific abstracts came up,

By jawbone on Fri, 01/09/2009 - 9:47pm

along with a letter suggesting that mad cow type disease infected animals NOT be burned in incinerators as the prions might become airborne. And not destroyed. Found near middle of this list.

Damn, reading this is scary!

TSE Inactivation

Writing in a study on prion transmission, Dr. C. Weissmann
of the Medical Research Council Prion Unit of the Institute
of Neurology in London stated:

"A striking feature of prions is their extraordinary
resistance to conventional sterilization procedures, and
their capacity to bind to surfaces of metal and plastic
without losing infectivity."[7]

The Centers for Disease Control and Prevention reports that
"Prions are characterized by extreme resistance to
conventional inactivation procedures including irradiation,
boiling, dry heat, and chemicals."[8]

The World Health Organization (WHO) writes, "TSE agents are
unusually resistant to disinfection and sterilization by
most of the physical and chemical methods in common use for
decontamination of infectious pathogens." The WHO goes on
to note "infectivity is strongly stabilized by drying" and
that "contaminated materials should be kept wet between the
time of use and disinfection by immersion in chemical
disinfectants."[9]

In a scientific study on the heat resistance of the scrapie
agent, Dr. Paul Brown observed that TSE agents "are
notoriously resistant to most physical and chemical methods
used for inactivating pathogens, including heat".[10] Dr.
Brown is a leading authority on prion diseases and prion
inactivation. A 1998 article by Dr. Brown in the Lancet
includes the following discussion of prion inactivation:

"The agents that cause TSE have been known almost since
their discovery to have awesome resistance to methods that
quickly and easily inactivate most other pathogens...TSE
agents are very resistant to virtually every imaginable
method of inactivation, and those methods found to be most
effective may, in one test or another, fail to sterilise.
It seems that even when most infectious particles succumb to
an inactivating process, there may remain a small
subpopulation of particles that exhibit an extraordinary
capacity to withstand inactivation, and that, with
appropriate testing, will be found to retain the ability to
transmit disease."[11]

Dr. Brown's discussion of heat resistant subpopulations
refers to experiments by Dr. David Taylor, who is perhaps
the world's leading expert on prion inactivation. Dr.
Taylor published a study in 1998 showing that during heat
inactivation, small subpopulations of TSE agents can become
rapidly heat-fixed, and that these thermostable
subpopulations may survive to resist further attempts at
inactivation. The resistant subpopulations can be
differentiated by their longer incubation periods in test
animals.[12]

In a study on the effect of dry heat on the scrapie agent,
Dr. Taylor notes that prions "possess a number of properties
which differentiate them from conventional microorganisms,
including an exceptional resistance to inactivation by
chemical and physical methods".[13]

The most relevant study on heat resistance of TSE agents was
done by Dr. Paul Brown et al., published in 2000. Brown
exposed one-gram samples of scrapie-infected hamster brains
to various time and temperature parameters. The resulting
samples were injected intracerebrally into healthy hamsters
to test for residual infectivity. Samples exposed to 600°C
and 1000°C for 5 minutes resulted in no detectable
infectivity. A sample exposed to 600°C for 15 minutes,
however, infected 5 of 18 hamsters.[14]

The fact that 5 of the test animals became infected is
remarkable, since it seems likely that exposure to 600°C for
15 minutes would decompose all organic compounds. This
enigmatic result led Brown and colleagues to propose various
explanations. They note "combustion is a series of
pyrolysis and oxidation reactions that proceed rapidly but
incompletely," and that 600°C is a "comparatively low
combustion temperature". (My emphasis)

And there's more in the letter.

Is this what you wanted?

Here's a blog which covers mad cow disease (along with other organic farming info at home page)--and has this article on study showing infectivity in animal fats--try to avoid any of that with your steak and hamburger! Hell's bells! Scary!

Dr. Gupta has the Party Line on Prions

By kelley b on Fri, 01/09/2009 - 10:11pm

Unfortunately, the Party Line is ignoring scientific evidence.

In modern medicine, you are only allowed to profess the opinions you are allowed to profess by your institution's lawyers. Until the consensus says prions are a deadly danger everywhere they occur, no Serious doctor will countenance their peril.

Fortunately I'm a Ph.D., and not qualified to dispense medical advice. Only analyze data.

Don't kiss any hunters, either. Just sayin'...

—

No Hell below us
Above us, only sky

I'm off to search the New Yorker archives

By trishb on Sat, 01/10/2009 - 1:21am

My memory is quite odd, so I can't say when the article I read about this was printed, but I know it exists. As usual with the New Yorker, the article was very in depth.

Replying to myself because

By trishb on Sat, 01/10/2009 - 1:51am

I hadn't updated my email addy, etc with the New Yorker since my divorce. I've found the article abstract online, but I now need to wait 24 hours to access after updates.

This typifies one of my chief objections

By spiceweazel on Fri, 01/09/2009 - 11:40pm

to Dr. Gupta. (Disclosure: I'm a physician.) Pursuing an unrelated interest, I spend a lot of time on the road with a hotel TV tuned to CNN, and I catch a lot of Dr. Gupta on the weekends. All too often, after watching him, I am left wondering WTF the public takes away from his presentations. *sigh*

If you're a physician...

By lambert on Fri, 01/09/2009 - 11:48pm

... can you point me to some prion links?

I mean, gupta's saying it's OK to eat prion-infested meat if you cook it. Is that right?

—

"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi

Not exactly my area of speciality...

By spiceweazel on Sat, 01/10/2009 - 12:55am

but will try to find something. In the meantime, I seem to remember that some UK victims ingested infected hamburgers, which I presume were cooked. Cats, which are also susceptible, got it from eating infected cat food, which commonly contains rendered animal remains (heated to high temperatures).

Here's a link from a site I think is reputable:

Mad Cow Disease and Variant Creutzfeldt Jakob Disease
http://www.emedicinehealth.com/mad_cow_disease_and_variant_creutzfeldt-jakob_dis/article_em.htm

Prions are highly resistant to heat, ultraviolet light, radiation, and disinfectants that normally kill viruses and bacteria. Prions may infect humans who eat meat from infected cattle. Even cooking meat infected with BSE does not eliminate the prions or the risk.

If you'd like links to original case reports, I can try to locate some. (Apologies for coding inadequacies.)

More...

By spiceweazel on Sat, 01/10/2009 - 1:00am

The main problem is contamination of meat with infected/affected neural tissue, which occurs during processing, hence the problem with ground meats and rendered remains.

I'd have to do some more digging to see whether there's consensus on whether something like a cooked filet is "safe".

I'm not in the medical field in any way

By trishb on Sat, 01/10/2009 - 1:55am

But the key take aways as I remember from the whole CJV/mad cow issue were 1) no - cooking didn't help, and 2) yes - large steak-like parts were better than ground beef. Standard ground beef in the US can be blasted off the carcass which can include the bits you really don't want. For a while, I would pick out a decent cut of meat and have the butcher grind it up. Any piece or part that included potential neuro-tissue was suspect.

Please tell me this is the right way, or just put me down when I start the twitching, please.

Edited: to add a word that made more sense

a little perspective on "mad cow" prion disease

By bringiton on Sat, 01/10/2009 - 2:16am

Definitions and acronyms: Mad Cow is formally called Bovine Spongiform Encephalopathy (BSE), bovine for cattle, spongiform for the little sponge-like holes that form in affected brain tissue, and encephalopathy for a disease of the brain. When humans contract spongiform encephalopathy from eating the tissue of BSE cattle, they develop what is called variant Creutzfeldt-Jacob Disease (vCJD). The "variant" part is to distinguish this particular disease from another closely related neurological disease, Creutzfeldt-Jacob (CJD), which is very rare but has long been recognized. The cause of CJD is unknown, but 10% or so of the cases are clearly familial most likely a genetic predisposition. The other cases have no known cause, but presumably are the result of some unusual genetic susceptibility and environmental exposure. Oh, and: prion is pronounced pree'-än.

From the late 70’s onward I traveled to the UK regularly and ate plenty of beef including calf’s brains, sweetbreads and assorted sausages of unknowable but tasty composition. When the vCJD outbreak was recognized, I became what you might call an Interested Party. After the first couple of years, however, my apprehension diminished as it became clear that the feared widespread outbreak was not happening.

Below is a graph showing the number of CJD and vCJD deaths in the UK from 1990 through 2007. Currently in the UK, the chances of dying from CJD are 1:750,000; the uptick occurring after the appearance of vCJD is felt to be the result of more sophisticated diagnosis of what is a rare and difficult to recognize disorder. The chances of dying from vCJD are much lower, around 1:2,000,000, and the number of deaths per year has diminished rather than continued to climb as was first anticipated.

Deaths from CJD in the US are roughly the same as in the UK, around 1:1,000,000, as shown in this graph from the CDC. There have been three deaths from vCJD in the US as of June 2008, two from probable exposure to beef products while resident in the UK and one from Saudi Arabia.

The risk of contracting vCJD in the US is nil. The risk for a full-time resident of the UK, even someone who has eaten a lot of beef, is very low compared to other causes of death. For comparison, this graphic shows death rates for various causes in the US compared to the risk of death for vCJD in the UK:

There are things I worry about dying from, a little now and then, but vCJD is not one of them. To the extent that Sanjay Gupta was able to calm anyone’s unreasonable fears, I suppose he did some good. It would have been better if he hadn’t misinformed while doing so. Regardless, I think he’s a useless tool and I’d rather have someone of substance and gravitas in the position. Fortunately, the job carries almost no authority that means anything in reality; if an actual precipitous health crisis comes along, Public Health Service staff will know what to do.

"Well, _I_ didn't get it."

By TonyRz on Sat, 01/10/2009 - 11:51am

Yeah, that's helpful Public Health info.

Bottom line - you can't cook it away and Dr. HappyPants said "Cook, don't worry."

Say anything stronger than that, and you'll find yourself sued like Oprah.

the difference between rational and irrational

By bringiton on Sat, 01/10/2009 - 1:04pm

fears is what I was pointing out, but perhaps that's a challenge to grasp for some.

It appears, after a lot of clever research by a lot of very smart people, that contracting vCJD requires (1) a substantial amount of exposure to contaminated tissue and (2) some unknown pre-existing, probably congenital susceptability. Neither of those are common, so the probability equation of not very likely multiplied by seldom seen equals hardly a worry. Advising the public that there is nothing to worry about when in fact there is nothing to worry about is, actually, sound Public Health policy.

Not to defend Gupta who in my opinion is, I repeat for the third time here to the benefit of those unable to comprehend quickly, a useless tool.

Why anyone would defend the needless spreading of false rumor, the willfull damaging of the innocent, and abuse of public trust through dissemination of lies and incitement to panic, who can tell? I will not weep for Oprah and her endlessly braying, self-serving maw.

And girls, douche with Cola after he touches your special place.

By TonyRz on Sun, 01/11/2009 - 2:03am

Advising the public that there is nothing to worry about when in fact there is nothing to worry about is, actually, sound Public Health policy.

Actually, advising the public that thorough cooking with a meat thermometer solves the problem is not sound Public Health policy.

That he thinks that there was not an opportunity there to discuss modern food production dangers tells you why he's Obama's man.

There was no problem and there is no problem

By bringiton on Sun, 01/11/2009 - 2:27am

which is, when you think about it, your problem in trying to cobble together an argument that there is a problem. Plus/minus Gupta and his ignorance, there is no problem with vCJD in the US and there never has been. Gupta's flaws in this particular instance are inconsequential; eat US beef raw or as jerky, it makes no difference. Dispute the data if you can; otherwise, you have no case to discuss with me.

The beast is here, like it or not.

By TonyRz on Sun, 01/11/2009 - 2:37am

Are human folks sick from vCJD RIGHT NOW? It appears not to be the case.

Do we have downers right now? Yes.

Do we have and spinal material refed to animals, including pigs (apparently under the belief that well, if you feed it to a non-cow it's alright)?

Abso-freakin-lutely.

Does cooking remove any MC risk - at all? None. Nada. Nihil.

Those are the facts, sweet-cheeks.

Equip everyone with personal lightening rods

By bringiton on Sun, 01/11/2009 - 2:43am

and mandate their constant presence. You'll save more lives that way, bitter-cheeks.

Can't we just enter tham all into a big database?

By TonyRz on Sun, 01/11/2009 - 2:53am

That will stop errors on farms!!!!

Not "we"

By bringiton on Sun, 01/11/2009 - 3:02am

you've already said you can't handle the task, so someone else will have to do it.

Fortunately, the French have already worked through development and implementation of a comprehensive system that tracks every calf from conception to counter; we can just buy theirs, no problem.

Dr. Happypants -- haw!

By lambert on Sat, 01/10/2009 - 12:10pm

And the ability to calm fears while purveying misinformation is either (1) the sign of being a successful weasel, or (2) a job qualification

Because I've been watching Obama on health care since he ran the Harry & Louise ads in Ohio, I'm concerned that his answer is behind door #2.

—

"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi

Door #2, certainly

By bringiton on Sat, 01/10/2009 - 1:42pm

But Gupta would pander misrepresentations just as eagerly at CNN as he will from the Surgeon General's office, and in America today I don't think the general public gives one source any more credibility than the other. I'd rather he went back to private practice, dispensing bad advice to one person at a time instead of doing it wholesale, but that isn't likely. He's a media darling, an actor and a performer, who like Bill Frist and a few others has let his ego outstrip his obligation to the Hippocratic Oath, but unlike Frist he isn’t a scold so he’ll remain popular and ever-present for decades to come.

Speaking of outsized egos and since we're here, assuming that Gupta gets the new gig who will replace him as America's new most wonderfullest MD? I have my money on the extraordinary Mehmet Oz. He's smooth, soulful, credentialed, mediagenic and a fellow who never passes up any chance for self-promotion. I wouldn't let him touch me, much less follow his advice on anything, but Oprah loves him and she's determined to make him a big star just like Dr. Phil. Oprah Winfrey is a sort of a prion person, warping broad swaths of the entertainment industry and clogging up with gunk the neural pathways of a whole generation. I don’t fear Mad Cow, but Enthusiastic Oprah makes me quail.

Testing animals seems to be the best way to keep mad cow out of

By jawbone on Sat, 01/10/2009 - 6:53pm

the food chain. What was alarming from BushCo is that they refused to permit a meat packer which wished to export to Japan to hire private labs to test each animal--in order to meet Japanese requirements. This made quite a bit of news at the time. Bcz it would cast doubt on US beef....

In WI, when a mad cow variant which affects deer was discovered, culling was tried--I'm not sure how well it worked out. For a while, hunters were supposed to send each deer head from a hunt kill to Madison for testing prior to using the meat from the deer ( the carcass would be frozen).

In France, the heritage and history of each slaughtered beef animal is known and tracked. IIRC.

BIO, I agree the chance of getting this disease is low. I do have relatives, however, who raise their own beef and feel much more confident about avoiding it than those of us who purchase through the regular food distribution channels. Very good beef--had some of Tenderloin when I was visiting. It's a different feeling when you know the name of the cow's meat you're eating. I enjoyed it and was appreciative of the efforts to raise Tenderloin--and to Tenderloin for providing the meat.

I'm all for eating the beast you know

By bringiton on Sat, 01/10/2009 - 7:56pm

but that's a difficult approach for the vast majority of people who don't have acreage. For me zero chance equals zero chance, regardless of the source of the meat that translates into zero chance. At some point the fear becomes an unreasonable one - no less real for those in the grip, to be sure - and that's where it would be wonderful if we could rely on either the government or private industy to be honest and helpful. The greed and incompetence of both are what drives these fears, you're right about that, and hopefully at least the government side will now begin to change.

The presence of prion disease in deer and elk, Chronic Wasting Disease (CWD), isn't anything new either, although rising populations may be driving up the incidence, and even though the CWD prions are found in muscle tissue we have no documented cases of transmission to humans. As with British beef, I would not hesitate for a moment before tucking into an elk roast or a venison stew.

Oh, Sanjay, you're a-DOR-able!

By TonyRz on Sun, 01/11/2009 - 2:14am

From the Anderson Cooper transcript:

Gupta: [] There has never been a case of the human form of mad cow disease, known as CJD -- there has never been a case of it in this country.

COOPER: How does someone know if they do have mad cow disease?

GUPTA: You know, that's the interesting thing, Anderson. It can be about 10 to 15 years before you would actually develop any symptoms from -- from the human form of mad cow disease.

So, it's really hard to go back and try and figure out where it came from. And you probably can't remember what you had for dinner last night, let alone 10 to 15 years ago. So, it would be very unusual.