COMMENTARY

June 2004: Mad Cows and Editors

Priscilla Scherer

Disclosures

June 15, 2004

Late last year, December 23 to be exact, my family stopped eating beef and processed beef products. No hot dogs, no bologna, no hamburger deluxe or sloppy Joes, no tenderloin, or eye round -- no beef period, bone or no bone. That was the day when we learned about the "mad" cow in Washington and watched as the US Department of Agriculture reassured everyone that US beef is safe, even despite poor oversight of processing, testing, and regulating cattle feed, porous borders, and so on.

Soon after that -- Christmas Day, to be exact -- I started feeling as though I was being unreasonably paranoid. Everyone we knew was serving beef for Christmas dinner, with pride and not an ounce of misgiving. Maybe they all missed the news that week. But no...they hadn't missed it; everyone said various things about "the cow" being on the other coast, about it being a problem for meat near the bone, about how they didn't eat that much beef anyway, and about McDonald's issuing statements about the safety of their meat (and of course, McDonald's and Burger King and the rest have never deceived us about what's in their products, or the kind of oil they use for frying fries).

It's been that way for months. I seem to be the only one I know who has any doubts. And that seems to be true across the country. A story in JAMA reported that Gallup Poll results found only 17% of Americans had reduced their beef consumption as a result of that cow. I started wondering whether I was being unreasonable, with all my questions about the nature of prions, transmission, cattle feed, scrapie, and the meat supply.

For example, if Creutzfeldt-Jakob disease (CJD) is transmissible via a scalpel nick to the surgeon's finger (through the bloodstream to the central nervous system) and if there is at least a theoretical risk of transmission via blood transfusion, then why not in muscle meats? I know it's a dose thing, but how much is too much? Why are young cows less likely to be affected than older ones -- particularly if they've been fed cow blood? Why is muscle meat, away from the bone, considered safe even though it's bloody? I knew that many of my questions were stupid -- a case of a little bit of knowledge being a dangerous thing -- but my questions remained, nonetheless, and I started becoming paranoid about my paranoia.

I searched the news for answers to my questions. Not there. I emailed an expert -- not even the expert, an underling who did not respond to the email, which, of course, made me feel like my question was too stupid for him to bother with. Then, at last, I turned to Medscape -- and what took me so long? It's where no question is too stupid, too private, or too paranoid to find an answer, even if the answer is "we don't know yet."

In all, I found about 30 articles and news reports about bovine spongiform encephalopathy, prions, variant CJD, and mad cow disease. I also found that some of my questions weren't really so stupid; they just don't have answers yet. A few of these articles provided the nuts and bolts just after the news broke ("BSE: First Presumptive US Case in Cow"), but some, eg, "The Prion Diseases" from Seminars in Neurology, are comprehensive reviews of prions and the diseases that result from them; and others, notably "Conference Report - Spongiform Encephalopathies: A Tale of Cannibals, Cattle, and Prions", from MedGenMed, provide scientific and historical analyses of research presented at a national forum last year. Finally, I made use of the MEDLINE search tool and found "Possible Transmission of Variant Creutzfeldt-Jakob Disease by Blood Transfusion" from the February 7, 2004 issue of The Lancet.

OK, so I didn't find definitive answers to all or even most of my questions, but that's because no one has all the answers. But I'm feeling less stupid and less paranoid, and I know a heck of a lot more about prions than I did a few months ago. I also know a heck of a lot more about the cattle industry, which is why we're eating beef again, but only from grass-fed and soy-fed cows.

If you have comments or questions about this editorial or the Neurology & Neurosurgery site, please contact me at neuroeditor@webmd.net.

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