Why Americans should ingest more excrement.
One year ago, the now-famous E. coli outbreak arising from contaminated spinach rattled the natural-food industry and gave carnivores a moment of schadenfreude. The story had the heartbreaking elements we have come to dread: A young child eats something mundane and dies a horrid death. Boom, gone. I have (unsuccessfully) treated one such case and rate it as perhaps the most chilling moment of my career.
Since then, the United States has seen at least four additional food-borne outbreaks: salmonella in peanut butter and in spinach, botulism in canned chili, and the current Topps Meat Co. recall of 21.7 million pounds (40,000 cows' worth) of E. coli-tainted ground beef. Those with an insatiable interest in E. coli O157:H7 (along with the lawyers who traffic in this corner of the human misery market) can keep up-to-date here.
With every outbreak, the same question sounds: Why can't we keep the food chain clean? The annual numbers aren't small, nor are they decreasing. By one estimate, about one-fourth of Americans get "food poisoning" of some type each year, 300,000 are hospitalized, and a few thousand die. The perps remain the same—E. coli, listeria, salmonella, and all the rest. Why is this public-health problem so difficult to solve? This is America, after all, replete with wondrously harsh chemicals that can kill anything. Why can't we scrub away the bacteria our guts don't get along with?
Maybe we are taking the wrong approach. Rather than trying to make our food and water ever cleaner, we should focus instead on making sure it's dirty enough to assure our good health.
Here's why. Our struggle to purify food and water has been ongoing for thousands of years. Ask any expert to name mankind's greatest public-health advance, and the answer will be not vaccines, or antibiotics, or disposable diapers, or refrigeration, or mosquito netting. Though wondrous, each is dwarfed by the greatest invention of them all: plumbing. Why did the Romans successfully rule the world? The Cloaca Maxima, ancient Rome's elaborate sewer system, a structure so effective that Pliny the Elder considered it the "most noteworthy" accomplishment of the empire. And why does the West still run economic circles around the developing world? Because we don't ingest each other's excrement. At least not that often.
The triumph of Western civilization is, first and foremost, a triumph of pipes and valves and the fact that water runs downhill. Aqueducts bring fresh water in, cobblestoned underground tunnels move used water out, and, presto, our world is clean.
But here is the problem: We have become victims of our own success. Ever wonder why your dog can gobble, lick, and gnaw all he wants along the glorious buffet of a city street and (almost) never get sick? Your dog is used to eating shit. Americans, on the other hand, grow up eating almost no shit at all. Our food is hosed and boiled and rinsed and detoxified and frozen and salted and preserved. Recently, we have begun to irradiate it, too—just in case. As a result, when our bodies encounter the occasional inevitable bug, they're unhappy. Our centuries-long program of winnowing out all the muck has turned us into sissies and withered the substantial part of the immune system mediated by our intestinal tract.
Kids have it worse than adults. Even with today's near-sterility, adult intestines have learned enough tricks to ward off major trouble, albeit clumsily. In contrast, modern kids are near-bubble babies. Our mammalian disaster plan is a good one: A child receives antibodies against countless infections from his mother through the placenta and then from breast milk. With that protection, the infant can take his time to develop his own antibodies. But these days, mothers have scant immunity because they too were raised in America the Hygienic. (Also, breast-feeding may be skipped.) So, kids have zero experience with routine gut infections, and when they encounter one that has slipped past our pipes and filters, the result can be catastrophic.
The best response to E. coli and the other pathogens that cause food poisoning is to recognize, humbly, that we can get the food supply almost perfectly clean, but never completely. There's just too much crap out there: human crap, horse crap, cow crap, pig crap. In the feces of these and other animals are trillions of infectious agents (bacteria, viruses, fungi, worms, and everything else that upsets the stomach). Try as we may to contain the mess, we can never win. Pig dung fouls rivers; cow crap seeps into water tables; human shit kicks back every time heavy rains overwhelm a sewage system's filtration capacity.
Furthermore, the closer to nature we get, the likelier we are to eat more shit. That's a growing problem now, as more people seek a less processed, more flavorful diet. To make matters worse, the alliance of natural foods with big-league distribution systems has guaranteed that people across the country can all simultaneously eat the same E. coli-laden spinach or meat grown by the same farm. The two key aspects of a healthy diet—nutritious food and safe food—seem irrevocably at odds with each other. How can we have what we want and still feel safe?
Maybe we can't. Observant Jews long ago sided with safety over taste by boiling, boiling, and then boiling some more. Cholent is the Yiddish word for food that is prepared in advance of the Sabbath, when ovens cannot be lit. Cholent cooks on a hot plate for 18 hours or more, pushing the food to within an inch of its life. Without ever sampling it, you can imagine its perfect non-ness, not even a hint of taste. But oh-so-safe.
Failing the mainstreaming of McCholent, what other options do we have? We can't just put all the crap back into our diet—we would suddenly see infant mortality rates that rival those of Angola. But we will never remove it all, either. So, here's a suggestion: Rather than frantically throwing money at new ways to eradicate the pathogens that reside in shit, we should fund the boring scientists who focus on untangling the intricacies of the gut's immune system. Labs, answer this: How much shit can we safely eat and, as importantly, how much must we eat to remain healthy?
Kent Sepkowitz is a physician in New York City who writes about medicine.
Photograph of beef patties on Slate home page by Justin Sullivan/Getty Images.