Whenever foodborne outbreaks hit the news, such as the recent ConAgra E. coli O157:H7 outbreak from ground beef, the question always arises: Why don't consumers take more care with handling and cooking their food? All of the illness cases in the ConAgra outbreak could have been avoided simply by cooking the burgers completely.

Although surveys have shown consumers don't seem to be aware of the etiologic agents involved in outbreaks or key concerns about handling and cooking foods, the reality is simply that most consumers simply tune out such messages. In the case of the ConAgra E. coli O157:H7 outbreak, a father of one of the cases indicated he "thought" his burgers were cooked well-done, but in the future he would use a thermometer to check this. Why didn't he do this before and avoid the calamity that befell his family? Here was a situation in which the hazard was known and the critical control point (CCP) was known, but the consumer failed to monitor it. Why?

Many surveys have been done on this topic, but they really don't get at the root cause of the risk-taking behavior of consumers.[1] In what follows, a different perspective on the reasons for consumer behavior will be outlined based on simple logic, simple risk assessment and simple psychology.

What Risk?
The first question we have to ask is of ourselves: Is there really an excessive amount of risk-taking by consumers? This is not as obvious as it might first appear, given the self-serving "scare tactics" about foodborne disease by the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the U.S. Food and Drug Administration (FDA) and activist organizations.

Consider the current issue of E. coli O157:H7 in ground beef. What risk is the consumer really taking on when he fails to cook a burger completely? Let's assume:

1. CDC's somewhat bloated estimates are actually correct.[1,2]
2. Burgers average 0.25 lb. in weight.
3. 50% of cases of E. coli O157:H7 occur in ground beef.
4. A typical person eats, at most, 200 such burgers per year.

That works out to odds of 1:50 of a burger-lover getting an E. coli O157 infection during his lifetime, but only to 1:800,000 odds of him being infected on a single eating occasion.

What about getting Salmonella from undercooked eggs? Let's assume:

1. 1:20,000 eggs are contaminated with Salmonella typhimurium Enteriditis internally.
2. The average person eats, at most, 200 eggs per year (i.e., two eggs for breakfast, twice a week, every week).
3. The chance of a particular eating occasion involving sufficiently undercooked eggs to cause disease is 10%, given the eggs are contaminated.

The odds are 1:6.25 that an egg-lover would get a Salmonella infection from eggs during his lifetime, but about 1:100,000 on a single eating occasion.

It's important to understand risk from a consumer's point of view: The risk of disease on any given occasion is extremely low, on the order of 1:100,000 or less. A consumer may be forgiven for believing that it's unlikely to make a difference what he does with this particular meal. On the other hand, the cumulative lifetime risk does present more risky odds of 1:10 or less, so prudent behavior conscientiously applied over an entire lifetime can help 1 of 10 people avoid disease. But how many consumers would be willing to apply this much work in order to eliminate 1:10 odds over their entire lifetime?

Previous analysis has indicated the total risk of foodborne disease in the form of a mild diarrhea episode from all sources is about 1:20,000 per meal, or about once in 20 years for an average consumer.[3] The typical consumer would find this risk bearable, and would not likely make fundamental changes in behavior to guard against it. (For comparison, the odds that a typical consumer will die by being struck by lightning is 1:28,500.)[4] The consumer also realizes that when a calamity occurs, negligence has happened somewhere earlier in the system. It is not solely his actions that are at fault, and he is powerless to control the failures of growers and processors.

Wolf! Wolf!
A problem with intelligent risk assessment by consumers is that everyone is shouting at them with scare-tactic slogans. CDC, whose funding is based on the population's fear of outbreaks, routinely multiplies actual cases by 100 to1,000 times before presenting estimates in press releases.[2,3] Their numbers also are portrayed in the starkest possible form, as gross numbers, not adjusted per unit population and per meal served, as would be done in professional journals for scientific purposes. We hear about 76 million illnesses per year, with no standard of comparison as to how to assess the importance of this number.

USDA and FDA do not help by mandating excessive recalls when outbreaks do occur. Instead of admitting that a few tens or hundreds of thousands of pounds of product three months in the past were the only units implicated, they mandate (by "request") recalls that extend to 20 million units or more and to months or years in the past. They do this knowing that 99% or more of the recalled units will never be retrieved. (In the recent ConAgra outbreak, 19 million lbs. were recalled with only an estimated 10,000 lbs. retrieved.) No cases of illnesses are typically associated with any product in these expanded recalls.

The press clamors for historical "firsts," or at least "seconds," and plays the large mandated recall numbers for all they are worth. They rarely, if ever, mention that no new cases are typically discovered after CDC publishes its findings, which usually happens contemporaneously with the regulatory-mandated enlarged recall.

Consumer activist organizations depend upon fear and hype for donations, so they push to the forefront in pointing out the perils not dealt with by industry.

How then should the consumer assess the risks associated with his behavior? From all trusted sources, he hears "The sky is falling!" and "Wolf! Wolf!" But this is in contradiction with his own experience, which is that foodborne disease is rare (remember the 1:100,000 odds per meal?). He notices that every year people are living longer. What then does he do? He tunes out those messages, much as he does commercial advertising or other public interest exhortations. And he doesn't change his behavior much in response. "If it's going to get me, it's going to get me."

Risk in Every Bite of Every Food?
Not only does every source bombard the consumer with the "enormous" risks associated with eating food, a simple life activity, but every type of food has been smeared with the tar brushes of activism, regulation and the press. The air is not safe, it's filled with carcinogens and noxious gases. The water is not safe to drink because of carcinogens and parasites. Meat is demonized by the press. Produce is increasingly implicated in outbreaks and Third World contamination. Even bread, the "staff of life," which has never before been associated with foodborne disease except when moldy, is now a source of the carcinogen acrylamide.

What then should a consumer do: Not eat? Not drink? Not breathe? Should he drink only bottled water and only canned food? Put a HEPA filter in every room? As a consequence of this universal scare-mongering to win market share, a larger budget or more donations, the consumer has been damaged in the process. The unhealthiest are paranoid, or at least neurotic, about foodborne disease risks, and do live off bottled water and "organic" foods. They believe the wildest rumors and develop a "siege" mentality. The bulk of consumers become apathetic about risk: It's ubiquitous and unmanageable, so why make any effort at all? Eat your burgers rare, and eat your eggs "over-easy." It's all full of bacteria and poisons anyway, so why bother?

Luck: The Gambler's Paradox
Most people think that our 21st-century world is a marvel of technology and scientific thinking. In reality, superstition plays a much larger role than science in our lives. Modern superstition is epitomized in the idea of "luck." If you buy a lottery ticket with 1:1,000,000 odds and you win, then you're "lucky" and the "gods have smiled upon you." People want to be associated with you, so your "luck" will rub off on them. However, if you contract a disease that only 1:1,000,000 people get, you're "unlucky" and there must be something you or someone else has done wrong. You become angry, because you are not a bad person, certainly not bad enough to "anger the gods," so it must be somebody else who did this to you. You want to punish that somebody else for ruining your life.

"Luck" determines the risk-taking behavior of consumers. The risk of having any problem at all with food is only 1:20,000 for any particular meal, so only the "unlucky" are at risk. If you feel average or better in "luck," you don't worry and don't take any special precautions. On the other hand, if you're in the small minority who feel "unlucky," you take excessive precautions to avoid risk.

In statistics, this psychological stance is called the "Gambler's Paradox." It's just as real a phenomenon in consumer behavior as the "Hawthorne Effect" is in management. Suppose I roll a die and it comes up a 6 each time for 10 rolls. (The chance of this happening randomly is 1:60,000,000, a very small number.) Would you wager a 5:1 bet for or against a 6 on the next roll? The "Gambler's Paradox" says that a typical gambler would bet against the 6, even at worse than 5:1 odds, because it is due to come up something else! The statistic scoffs, and says nothing is "due," and the odds against 6 are still 5:1, no matter what previous rolls have been. (Oddly enough, a scientist would bet for a 6 again, because he believes what has happened in the past will continue into the future.)

What this implies about consumer behavior is that consumers are incapable of judging correctly about rare risks: they do not believe their risk is cumulative. If they did, they would understand why casinos make money and would never play there. Instead, they trust their "luck" and mistakenly believe that long odds are the same thing as no odds.

Insurable Risk
When odds of a calamity drop to 1:10,000 or 1:100,000 or less, the proper way to deal with risk is to manage it. To put it another way, it's an "insurable risk." This is the way our society has de facto dealt with foodborne outbreaks. The consumer does not alter his behavior. The producer does not alter his behavior. When the rare calamity strikes, large lawsuits are drawn against the producer under the doctrine of "strict product liability." Our anger at being "unlucky" pushes us to find at the food production level some indication of negligence or wrongdoing. The food company invol-ved has an insurance policy with a very large deductible, such as $1,000,000 or $10,000,000. A large monetary award is made by the jury, and the activists make press releases that feed headlines of the journalists. An appeal reduces the judgment to manageable proportions, the lawyers take 40-50%, and the victims get their medical costs paid. The insurance companies continue to raise premiums until they consistently make a tidy profit. The company takes a blow, but usually survives the process.

"Insurable risk": That's how it works.

Recommendations
Although we've learned how to live with foodborne illness risk, it's unsatisfying that we haven't convinced the consumers to do their part to reduce it. Here are a few ideas that might make a difference:

1. Quit prevaricating to the consumer about risks. Tell him the truth. Activists will always distort, but regulators should be balanced.

2. Stress cumulative risk in public messages. Indicate that the benefits of careful behavior may be small, but they do work.

3. Stress responsibility in public messages. When an E. coli O157:H7 event occurs, it's usually your child that gets damaged, not you. Isn't it child abuse to feed a six-year-old a raw burger?

4. Limit your messages to the real risks in particular foods. Don't try to scare consumers with every food, or they will take the opposite tack of what you expect. In only a few foods (sprouts, burgers, eggs) is it possible for specific consumer actions to have any significant effect. So why torment them with inflated estimates of risk?

5. Admit that our food supply really is the "safest in the world." Then give the consumer intelligent advice on how to deal with unknown, future risks. For example, inform and advise them to wash all fruit and vegetables before eating raw, or to cook eggs "over-medium" instead of "over-easy."

6. Put food safety into the high school curriculum. A large number of people end up working in a foodservice activity sometime during their life, and all of them prepare their own food at some point. Why is there no investment in educating them?

7. "First, do no harm!" By creating paranoia and a siege mentality, a fraction of our population dramatically alters its eating habits. What medical costs in development and malnutrition and mental anguish result?

8. Quit letting the "tail wag the dog." Growers and processors can alter the odds of foodborne illness much easier than consumers can.

Robert A. LaBudde, Ph.D., has been president of Least Cost Formulations, Ltd. since 1979, and has served on the faculties of several universities through the years, among them the University of Wisconsin and MIT. LaBudde is well known throughout the meat industry for his contributions in the areas of computer formulation, chemical analysis, quality control and computer formulation. He has published numerous research articles, holds several patents, and has provided consulting services to more than a hundred major manufacturers. LaBudde has been a Bell Atlantic Scientist, an Associate Referee of the Association of Official Analytical Chemists and a member of the Scientific Affairs Committee of the American Meat Institute. He is a professional member of many technical societies, including the American Meat Science Association, the Institute of Food Technolo-gists, the International Association for Food Protection, AOAC International, the American Statistical Association, the American Society for Quality Control and the American Chemical Society.

He is an active food safety ideologue, and is noted for his strong and sometimes controversial opinions.

References
1. Li-Cohen, A.E. and C.M. Bruhn. Safety of consumer handling of fresh produce from the time of purchase to the plate: a comprehensive consumer survey. J Food Prot. 65(8):1287-1296. 2002.
2. Mead, P.S., L. Slutsker, et al. Food-related illness and death in the United States. Emerg. Infect. Dis. 5(5): 607-625. 1999.
3. LaBudde, R.A. CDC estimates: the real message. Food Protection Inside Report, November 1991. (Also available as a 1999 Least Cost Formulations, Ltd. Technical Report, reference number TR161)
4. www.lightningsafety.com/nlsi_info/media.html