Articles, Blog

The costs of foodborne illness

December 10, 2019


My name is Piper Burton, I’m from the School of Agricultural Environment. I’m an economist working on issues about food consumption, food demand and for most of 2015 and 2016 I was on leave from working at University of Manchester in the UK on a couple of really quite large projects that were interested in this issue about food safety. So what I am going to do is talk about well, the big picture stuff to start with but then some of the things that came out of that study. Some of the interesting, fun things hopefully, which came out of that study. So go up to the global level, so this is out of work done by the World Health Organization. They did a huge global study trying to look at the impact of foodborne disease and it’s large. One in ten people fall ill, 33 million healthy life years lost, nearly half a million deaths and particularly focused with children and it’s children and the elderly who are the most vulnerable to these types of illnesses. What I’m particularly interested in is, sorry it’s just before your lunch, so this is interesting diarrhoea. Diarrhoea and vomiting are the own seeds of a particularly of concern and interest to these projects we are working on and so these are the
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biggest sector, the biggest element which well for about a half of the global Burden. And there’s a whole variety of different pathogens involved in this. Bacteria, viruses, parasites differs according to which country you’re in, in terms of development as to what actually is going to have the biggest impact. There are concerns that as globalized food trade occurs that if you have a problem in one part of the country because of the globalized networks it can spread really quickly. So this is a problem that if there is a problem somewhere then actually quite quickly it can spread throughout the world. One of the issues about food borne diseases is that they are, really all, very easily preventable and what really is the major way of preventing it is about actually how people handle and cook food. So especially in developed countries. So the burden that’s going to arise and we’re going to talk about is something which actually in some sense could be fixed quite easily and the question is that, the tragedy is that it’s not. So just some numbers for Australia. So gastroenteritis as in diarrhoea and vomiting, DNV as it gets abbreviated to. Large number of cases over 10 years, it’s dropped but there’s still about four million cases of this each year. In terms of looking at which are the main pathogens that are causing this, you’re probably all familiar with Salmonella which is the one sort of most people know but actually the one which causes the greatest number of cases is something called Campylobacter which I

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imagine you may not have heard about. Nobody knows, it’s sort of a, not a hidden but it’s an unfamiliar illness and then there are less, there are other pathogens which have less impact but quite often the ones with less impact actually have in terms of numbers have a higher impact in terms of health consequences. So if Shigella and so on, you can get to serious complications as in kidney failure leading to death. The bottom two are what in the these are the long-term consequences of getting a foodborne illness. This again is something which quite often surprises people. They think you’ve got an upset tummy, that’s true for the vast majority of people but at times those pathogens cause long-run impacts. So William Barr syndrome, that can lead to lead to kidney failure. Irritable bowel syndrome can go from something that is mildly irritating to something which is light which is really debilitating in terms of lifestyle and IBS, they are really quite a large number of cases. And Campylobacter, which we are going to focus on as we go through. You can, cause we are economists we are interested in and think of this in terms of economic costs not just measuring numbers of people. People have tried to put an estimate on actually what the level of the economic, the dollar cost of foodborne illness and it’s about 1.2 billion. That’s almost certainly an underestimate because those numbers when they were generated they were only looking at things like direct cost at in the cost of doctors and hospitals and productivity losses which is your days off work and loss in economic productivity. There’s this thing pain and suffering which actually turns out to be much more important or much more significant in terms of the total burden and we haven’t at the moment got numbers of that for Australia but if you look at the ones for the UK, so the NHS cost is these direct medical costs about 31 million, lost earnings, other expenses that sort of the lost productivity costs, 136 pain and suffering which is just the disruption to people of having from mild to really serious illnesses but it’s that’s of the cognitive impact is a factor where it’s the majority, the vast majority. Ninety percent of the costs are associated with this pain and suffering. So the Australian number of 1.2 is only picking up the first two of those. There’s this sort of hidden impact as well which is out there. So it’s a major issue and people are trying to find out ways of actually trying to control and manage it. So what interventions are possible and one of the, some of the things that we’re doing in the Manchester study was to look at different interventions, at different levels through the food chain producers in the avatars, in supermarkets but essentially most of this could be fixed at the kitchen level as in you can control this by just having good practices in kitchens. Either by professional cooks or by us essentially doing the right stuff. So one of the questions we want to know in this project was well can we start getting some idea and some information about what we’re going to describe as bad practices in kitchens as in people doing things which are actually causing this foodborne illnesses causing that impact. So this is a paper that’s being recently published it’s about restaurant cooking trends and increased risk for campylobacter. That is a really major illness in the UK and something of high importance for the Food Standards Agency and what we are really interested in here was what are the influences essentially of restaurants, celebrity cooks, TV programs, etc. on the way people behave and the way that they perform in kitchens. It’s about campylobacter cause campylobacter is the biggest pathogen in the UK. It also, these are sort of grabs in 2014/15 it also hit the media. Suddenly people became aware of the fact that about 70 to 80 percent of fresh chickens and that were being sold through supermarkets in the UK were infected with this thing called campylobacter which is something to just be known but if it’s been under the radar in terms of public awareness. It came on the radar and basically just had this massive media impact because you can get great headlines. Killer bug in most chickens. Poultry introduced dirty secret. So it has really a huge amount of public traction which is appropriate because it is the biggest impact and so this became, has become and still become a major issue in terms of UK food industry. You may be sitting here thinking well that’s the UK, this is Australia we’re fine. I’m looking up the most recent number for Australia. Australia chickens about 70 to 80 percent of Australian poultry on supermarkets contains Campylobacter. So this is not a small problem in a country far away. This is existing here as well. So what we were interested in? We were interested in this idea, this hypothesis that there was this move to pink but there was this trend in the way that people were consuming food where they were becoming more prone to want to eat meat in a pink state. So beautiful pink state where that’s all fine. That’s fine. Actually it turns out for steak and for red meats the problem comes though with chicken and the reason there’s a problem with chicken is that the pathogens are inside the meat, not on the outsides. So this is a screen grab which is reasonably okay from the British version of MasterChef. That’s a nice little consume and the bit of red that’s floating about at the back there is a chicken liver. And the description of this by the judges was this was perfectly cooked, beautifully pink and perfectly cooked. It’s a major, that’s actually a major problem because the pathogens in chicken are inside the meat. So if you’re eating that and there’s pathogens in the liver then basically, it’s just not being killed by the cooking process and the reason that all these problems could or the problem could be solved in the kitchen is that if you cook things properly i.e. not too pink in terms of chicken then you will kill the pathogen. Serving that is basically, you’re playing Russian roulette with chicken livers. So campylobacter is the food standard agency’s number one priority. They have guidelines about how you should cook chicken 70 degrees C for 2 minutes, should not be pink. If it’s pink you’ve got a problem. So then well Renton just put the culprits up. There may be some faces that you recognize there. Went and looked to see what TV and celebrity chefs were saying in terms of their cooking practices, in terms of recommendations, for how that you should be cooking chicken liver. So along the top now that’s the amount of time that they’re recommending, up to eight minutes, five minutes, there’s been people who’ve done evaluations of this in laboratories as to how long you need to cook chicken livers in order to kill the pathogens inside. It’s five minutes but as you can see there’s a whole series of people who are suggesting 30 seconds each side. Gordon Baxter, Nigel Slater who’s actually good a couple of minutes it’s only to get to Anthony Thompson they actually hit in the level and then some others are really cooking them properly. So this is the concern that there’s recommendations coming out from people who might have influence as to how you should be cooking your food and they’re probably making recommendations which aren’t good in terms of food health safety. So we know that seems to be happening ,we wanted then to follow that through further. So the research question was what the chefs and the public identify as safe cooking standards? Do they understand what is safe and is the divergence between what they think is safe and what they’d like to serve and eat? We had a limited amount of money so we couldn’t actually feed people. What we had to do was basically use this this instrument which is a set of photographs of chicken livers cooked to different levels and those isn’t really clear but number one is really quite pink if you saw it on a normal computer screen or just a photo it’s really quite pink. Number seven is looks like leather basically it’s being cooked really hard. So we’re presenting them with these these different images and just basically ask people well what do you think would be safe and what would you like to serve or eat? And those bottom three are the ones which we know if you ate them there’s a risk that they’re still carrying a high pathogens level. If the pathogen is in the liver, there’s a high probability it’s going to survive being cooked to that degree. There’s still some pink in there. So who do we interview? Well catering students, chefs, and the general public. We are interesting to know, we’re going to talk about here’s the chefs and the public and they’re get their views. So we ask different questions the public. We have had about 900 of these doing it online as in which you think is the first that meets sort of FSA safe food guidelines? Which dish would you prefer to eat at home? Which dish would you prefer to eat out? and this was limited to people who said they ate chicken livers. There’s a group of people who would say no I wouldn’t eat any of it, they would have to be taken out of the survey. The chef was, which is a smaller number, they would have recruited at chef cooking fairs. Which is the first that meets FSA guidelines? Which dish would you prefer to serve? and Which dish your customers prefer? So we’re interested in the guidelines and what they would rather to serve? So these are the public preferences and what’s happening in here is like a cumulative distribution. This is going to just show what proportion of the community proportion of the sample who would say yes that was either going to meet the guidelines or they have their preferences. So the way to read this is that these are quite consistent but about 10 percent are saying that they think that the first one meets guidelines. You’re getting up to about 20% think that either 1 or 2 are, about 25 to 30 % think that 1, 2 or 3 are and so on. So by the time we get to the end of that line we’ve accumulated all of our sample in. But you’ve got quite a proportion of people there who are saying both that they think that the those lower 1,2,3 are safe and it’s their preferences, that meets their Preferences. So what’s quite interesting about this is for the public there’s a consistency between what they think is safe and what willing to eat which is sort of what you’d like to see. It’s still a bit worrying though that are quite a big chunk of the proper the sample are saying that they would be happy to eat those really pink livers. The chefs look quite different. The red dotted line is their perception of what the guide, what the guidelines you know what the FSA’s guidelines are. So you can see they’re actually quite good. There’s only we’re about ten percent of them think that one two or three would meet the guidelines. So they’re aware of what the guidelines are and what they should be presented and as you as you go further up obviously we’re getting more and more saying yes it means the guideline. What’s interesting is the blue one this is the one about what they prefer to serve and what you can see is that most of them wouldn’t want to actually serve the first one but quite quickly fifteen percent would be happy to serve one or two and it’s up to 50 percent would be happy to serve, would prefer to serve not happy prefer to serve liver that’s in the one, two or three range. So here you can see that this divergence. They know what

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the guidelines are but they wanted to diverge from it basically in terms of their preferences and it’s a view of what is good food, what is flavoursome, what has the right mouthfeel and all the rest of it. It’s being driven into those preferences for what should be served and that’s a worry. It’s a worry if people are starting to serve the food in that way. It’s also a worry if this communication of these attitudes and views that are coming from the chef population are feeding through into the way that people are actually behaving in terms of their personal choices, the consumers choices. You can always send your pink livers back if you don’t like them but if you’ve ever been inoculated with the view that will actually pink livers of the way it’s supposed to go then it’s a problem. So they know the guidelines but they would rather serve it pinker. Fifty percent between one and three. We then ask people about influences. What are people’s views on what’s happening in the industry? We ask this about what they think other people do cause there’s always a problem at asking people what do you believe because they might not be prepared to say yes of course I’m influenced but they’re quite happy to say that other people like me are Influenced. So we ask them did they think that other people but we think actually this is about them how they’re eating, are they eating they meat pink because of celebrity chefs. 50 percent thought yes they could detect some impact and about the same portions of chefs think that there’s a trend among chefs recipes and towards cooking increasingly pink. This is a problem because when you get outbreaks of campylobacter based

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poisoning and by outbreaks that means we get large numbers of people being impacted at the same time not just singletons in. Outbreaks,

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quite often, associated with chicken liver and it’s because when people cooking chicken liver and chicken liver pate shows a similar problem they want pink but it actually harbors the pathogens and the reason comes an outbreak is that quite often this happens at catering occasions like weddings which is a great way to finish off your wedding is to have food poisoning. So there’s a major problem here about the way this perception is happening and feeding through. So what we found is that chefs know the FSA guidelines, prefer to serve it pinker. Public actually aren’t quite so good about the guidelines but at least they’re in line with the understanding of their preferences are in line with the guidelines so it would suggest that if we were to get more educated about the guidelines they would presumably change their preferences but the chef’s know there’s a different there’s a problem but still want to push a pink. And we did a test on this so that we’re actually when we were generating those photos at the same time there were chicken livers that were inoculated with Campylobacter, they were cooked for the right times and then we tested expose to see whether campylobacter Survived. The survival rates for those first three levels of cooking range between 98 and 48 percent survival. So if there was campy in the liver it would have survived the cooking process for those first three. It falls really fast when you hit the FSA guidelines not surprisingly because the survival rate disappears or drops. So there’s definitely a problem happening in there. Come back. So another thing we’re interested in was again this idea of bad behaviour, the chicken liver one which is about sort of it’s not illicit it’s not a bad behaviour, it’s just possibly a foolish behaviour, it’s about people’s preferences. There’s another set of behaviour though as well which is basically bad food behaviour as in people who are doing stuff in kitchens which they really shouldn’t be doing and is causing health problems. So another part of the study actually with the same sample of people we wanted to try to find out the prevalence of these illicit quote bad food behaviours. So what’s the questions. Determine the prevalence of bad behaviour among chefs and the public. How to what extent are people doing bad things in the kitchen and see whether or not in terms of the commercial side, whether or not these food bad practices are associated with certain types of establishment or characteristic. So can we predict where bad things are going to be happening? What do we mean by bad things and again I should apologize to you about your lunch but working in a kitchen within 40 hours, eight hours of suffering from diarrhoea and/or vomiting so there’s a recommendation that if as a chef or a food preparer you have had though vomiting an illness a stomach bug you basically even though everything’s cleared up you shouldn’t be working for the next 48 hours because you’re not what are known as shedding as you are still producing the pathogen and putting it out into the environment for 48 hours after you think that you’re fine. So there’s actually a recommendation which says you should not be working 48 hours after for the 48 hours after you have had the symptoms. That’s about behaviour. Have you worked in a kitchen where meat that’s on the turn has been served on the turn means I think it’s obviously not off but it’s on the edge it’s about to go from nice to nasty. So that’s a concern if actually people are serving food in that state. This is a sort of fairly basic one. Not washing hands after handling raw meat, poultry or fish. So one of the issues is cross-contamination with this. So if you’re handling meat chicken that’s been that has the pathogen on it and then you go and start producing salads then the pathogen just gets transferred from the chicken into your hands to the salad. So you should be having good hygiene standards washing, so the fairly basic stuff you thought should be going on. And the last one was serving chickens off barbecue when it’s not we’re not totally sure it’s fully cooked. This was in here because this is chicken it’s a complicated project so we’re interested in that. So we’d like to know both the chef and the public whether or not they undertake these types of
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Behaviours. Are these reasonable things to be worried about? Well there’s a restaurant called the fat duck in the UK. It’s run by Heston Blumenthal, who issue if you’ve been watching TV recently you’ll have seen his face telling up around the place. It’s a very high-end, very well established Restaurant. They had a problem with norovirus which is one of these pathogens. It’s not the more common ones but it is a serious one when it happens. One of the issues here was that apparently it wasn’t reported for a long time but when they went in and actually that the health agencies went in to investigate to find what the cause of this was what they were finding was that staff had been working even though they had been ill and that was all almost certainly the cause of the problem is that they hadn’t actually followed the guidelines as to how they should behave when they’ve been ill. These 240 diners have got Norovirus. So that, it’s a problem its’ out there. Working in a kitchen where meat on the turn has been served you’d hope this wouldn’t happen. This quote comes from a different research project but this is a quote from work from a chef about what they look for when they are employing new staff. Make a meal with chicken that’s on the turn as in didn’t just it’s not really rank but it’s getting there, can they do it? It’s important to do it because you can get another day or two meat out of, you know, economically it’s important and if they can do it then we know that they be experienced in restaurant cooking. So this is like an industry standard. If you can actually cover up the fact that your chicken is going, is about to go off then obviously worked in the kitchens before. Indication that possibly a standard activity that’s going on out there. It’s a bad behaviour, it’s an illicit behaviour. So we’d like to know about this but one of the problems of course is we’re going to be asking chefs do you do bad things and these types of questions are likely to prompt untruthful answers from people who sort of care about their reputation. So you can think of exact other examples of this is as in did you take recreational drugs at the weekends, all this the last weekends. Have you driven over the drink driving limits? Have you fiddled your tax return or you’re about to that’s about to come up. If I were to ask you to have a show of hands amongst you as to who’s performed these bad behaviours I imagine I wouldn’t get a very big response that you would feel yeah I don’t really want to admit I’ve done it but I don’t want to admit it. So how can we trust people if we are asking them to perform these behaviours especially professional people who have it’s a bad behaviour professionally. How can we actually be sure that we’re gonna get a good answer and they’re not just going to to say no of course not even though they do. So this is a problem when you’re trying to do this type of research as to how do you get people to admit they’re behaving badly? So there’s something called the randomize response technique and it’s been used lots of places. Most I think initially for drug use in the American armed forces but what you do is that you have a used dice a randomized process to try to change their answers. The answers that are recorded for people observed by dice rollers. How does this work? You give people two dice, before you answer the question you ask them to roll the two dice. I can’t see it, only you can see it. So the dice is hidden from view. Add the two numbers, up keep it secret don’t tell what your number is and then if the number is two three or four answer yes. Irrespective of what the question is or what the truthful answer is. If you get a two three four just say yes. If it’s an eleven or twelve just say no. Doesn’t matter what the question is nor what your truthful response is, just say no. Five, six, seven, eight, nine or ten, answer truthfully please. So what we’re doing is we’re sort of making bit strange we’re deliberately introducing error into our data. We’re actually getting people to not tell us the truth. We’re asking them to basically say yes or no determine you know just based upon a wrong. Why is this a good thing, well I’ve given you protection. If I ask you a question, Have you filled your taxes and you say yes you can always say it’s only because the dice told me to I’m giving you that answer not because I really did it but you’ve told me. I did the process roll the dice it was a two three or four therefore I’m going to give you the answer yes so I’ve given you some protection for actually revealing because I can’t actually now look you in the eye and say you’re a bad person you can just say I’m a good person, I’ve followed the roll. Even though, actually you truthfully have fiddled the taxes. So this idea of randomized response is a way of trying to actually give people protection so they can reveal the right answers. Does that mean our data is all useless? No, because we can work reverse-engineer this back out and say well we know that to know that a certain proportion of the sample are always going to say yes, a certain proportion are always going to say no and a certain proportion going to behave truthfully so there’s just statistically you can just work back with the say well this is what the true underlying level of behaviour is given that we’ve given this sort of this set up in terms of numerically. So this is quite a nice technique about asking people bad things. If you’re interested, it’s no good in court, it’s good if you want to talk about populations. So what do we do? What came out of this?

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So this is for the public, so this is not this is not the crude results this is the inferred results as to what the underlying rate of prevalence is. Not washing your hands after touching meat about 15 percent. Seems a bit high for the public the 48 hours after D and V that’s quite high that’s heading up to 30 percent but actually for the public that’s quite a difficult one not to do. You’re at home you’ve had you know what you’re going to do not cook for the kids for two days. So you might, may take more care but you probably if anything add balance a bit low almost you might think actually that most people would be forced just because of circumstances they have to cook till it. On the turn getting up beyond 20% and the barbecue chicken about 12% so that’s sort of quite high the on the turn, the barbecues of interest for the chicken so that campylobacter problem because that’s where we think actually a lot of the problems might happen with chicken. So that’s the public ones. What do you think the chef’s did? Not washing hands, thought be the things we drummed into a catering student day one. Okay it’s lower, it’s quite nice in the public one. The 48 hours D&V we’re heading towards 40% of chefs are saying that they’ve done that. So this is something which is actually a recommended practice that shouldn’t be happening. You should actually be out of the workforce for that time period. So that’s a really high level of a problem. Serving on the turn, it’s about the same thing perhaps not surprising given the quote we saw before but they are it’s like almost trained to really work out how to make the best use of their meat which means pushing it to the limits in terms of that whether it’s safe or not and barbecue chicken higher as well upper 20% so this is really quite a concern as in there are bad things happening in kitchens as particular among chefs that are going to be increasing the risks of this foodborne disease and this is increasing risks of things which basically you couldn’t reduce the risk to zero if you just cook the meat properly. Cook chicken so it’s not pink, one’s clear you can actually get rid of you could easily get rid of all of that implications for foodborne disease but there are these bad behaviours happening in the system. We wanted to try to find out whether or not can be explained it’s not everybody was saying it obviously a proportion did. If there’s some characteristics of the chefs and rinsing the chefs around the public as there’s some characteristics of the chefs which might explain whether or not they actually do these bad behaviours and if so that might give you some guidance as to where you might go. In the UK there is this thing called the food hygiene schools or as it’s known locally as the scores on the doors. Local Trading Standards officers go around to every establishment that sells Food, does an assessment of their food Hygiene, scores it between nought and five. If you’re down in the nought level, you’re closed down. One and two, you’re asked to Improve. You should really be hitting a five. Restaurants then get these little stickers they put on the door and they can therefore flag the factors to what that food hygiene rating is. If you’ve got a five you put it on the door flagged to the fact that you’ve got high standards. So this is things you’ve been pushed by the FSA as a way of trying to improve so that gives like to a consumer consumers can now actually influence behaviour by saying I’m not going to go and eat at somewhere that’s got a poor score. So it’s giving people information. So we can try to link, we asked the chef’s well what score does your restaurant have where you work for the school is and then is there any relationship between that score and their probability they behave badly. No. So it’s as likely that somebody in a five school or score of five is behaving badly as one has got to score of two. We asked them about the cost of their meals as in to get some idea of the degree of the cheap. No effect in terms of, no signal in terms of expensive restaurants don’t behave badly. It doesn’t turn up. We asked them, sort of a classification which sort of cost but the type of you know is it a fast Food, is it family dining, is it fine dining? You might hope and think that it’s fine Dining, well what it actually does it increased the likelihood that they’d not wash hand washing. So it’s going the wrong way a team in terms of if you’re trying to think about some sort of indication but only on that one behaviour. We also asked whether they’d won any awards which they won’t be like Michelin stars, these guys these will be like sort of local AA or local tourist awards or whatever for quality. What that was at in if you had been if your restaurant you worked in had won an award it actually increased the probability that you actually worked 48 hours without after D&V i.e. it’s the award-winning restaurants that are actually more likely to actually have the bad behaviours in them. That’s worrying but might be understandable in the same way that didn’t be the problem emerged presumably these guys are committed to the restaurant. Replacing them is probably quite hard because they’re skilled. It’s not like McDonald’s or whatever office of a lower level restaurant chain where you can just churn turnover staff but replace staff quite easily they probably have commitment and so they probably have a motivation to actually turn up as soon as they can and so we’re getting seeing that problem. So in combination, what that suggests is that the challenges for the public in finding outlets or safer food can be considerable and probably if you’re trying to use cues, they might give them to help. I must admit I wouldn’t eat in a restaurant that didn’t have a 4 or 5. The score on the door but this suggests that that might not be a good, necessarily a good predictor of some of these practices. Okay, conclusions. Foodborne illness is a huge issue. Imposes a considerable burden. In principle you could fix it just by cooking things properly. Bad behaviour’s everywhere and it’s actually quite difficult to change as in to make people change their Behaviours. So that’s part of the Challenge. So thank you. I hope I haven’t put you off. You referred to professionals, chefs as being professionals in what way do you define their profession and professionalism? I mean do they have a license to be able to cook our food, does anybody check on them? They have a lot of responsibilities both for the health and economy and should they not have a license like a driver’s license? So for us as in professional was defined in terms of that you are working in a commercial cooking environment. So you are you are cooking food which you’re going to sell to people. I don’t think that there is no requirement, there is no license for them. They will be trained where the standards are imposed will be from the Food Standards guys come in to actually see how they behave. Do they have good hygiene? So in principle, anybody could without any without any formal qualification turn up and cook. The way they are judged is on an assessment of the outcome of that as in they will be looked at again think they have guys outside selling pizzas Subiaco council no doubt will have gone round and inspected and we’ll have spot checks to see if they’ve got good standards. Whether you have a license well ok you could you could have a license but then as you know there are lots of people out there driving who got licenses who aren’t or not very good, who are problematic. So I think that sort of registration process might not actually help and we’ve seen with the people in the highest level as in they main you know into the higher end restaurants where you think there would be some degree of commitment pressures that they are actually places where these things aren’t just automatically fixed. So it’s a worry in terms of changing behaviour, that’s a real, it’s a worry. Probably the best way to do it is that when it turns up, it gets publicized and well-known and then people allow to make their judgments as to whether or not they want to eat in a restaurant. That’s being identified as having a problem. That’s what the schools, the doors is basically trying to do to give consumers information about stuff they can’t see that’s happening in the kitchen but the scores and the doors are actually quite I think if you don’t get a five I can you get everybody really it’s not a particularly rigorous system but now it’s yeah it’s a challenge basically. So you talk a lot of information about chicken and liver. I’m just wondering what do you think of the popular dish and sashimi in Japanese restaurant? So I think it goes to the quality of preparation and control. So you need to have absolute high quality standards and if you’re achieving those then presumably reducing the risks but so the other example is things like beef tartar which is like raw beef and the trend towards rare beef burgers. So and there’s a very clear distinction between those. In the sense that the issue about reason, why the trend to pink in beef isn’t so much of a problem is the pathogens are on the outside so that if you’ve cooked the beef and those steaks you kill the pathogen on the outside the meat in the middle is okay so that’s fine and that sort of trend to pink in terms of steaks whatever it’s in a sense. Fine you’ve got a problem. The problem comes when you

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ship something like burgers where basically what you’re doing is you’re taking the meat pathogens on the Outside, mincing its pathogens now all the way through, cooking it, the burger but only cooking the outside. You’ve basically put the pathogens back in. The pathogen in the middle are basically safe. They’re still existing in there. So this goes to the question about standard. Should you should you eat a rare burger? Well it depends upon preparation. If you prepared the meat to standards that you’ll be prepared to eat it I think it’s steak tartar which means absolutely really strong standards in terms of preparing the food, making sure that actually is time for known as sear and shave. You cook at the outside of the meat very quickly slighted off means the bit inside if you can achieve the standards, hygiene standards then you’re okay. The worry is with anything is that when people try to achieve those standards and fail or don’t bother to achieve the standards. But people still think it’s okay. So okay eating raw fish or chicken, not chicken, but well fish then, as long as your health standards are okay then you’re probably good. But the problem comes when it comes and there may be some people who can absolutely deliver high quality food but you need impeccable standards. The problem is when it becomes more widespread. Can everybody maintain? Can your normal burger joint to a normal chicken joint maintain the same impeccably high standards to ensure you’ve got that and probably the answer that is no. So that’s the worry. It’s about whether they can maintain the standards. You said something like 80% of chickens have the Campylobacter bacteria or disease or whatever it is. Is that related to how the chicken is brought up or is it pretty random. Is it you know your free-range or organic. Is that going to have less chance of having this no Campylobacter than at that tree. No so it doesn’t guarantee it’s not going to. So campy is in the environment. So it’s actually out there in the wild, in the UK it is, then you said cross infections into flocks. There are certain production processes which cause problems there’s something called thinning. Intensive where people go into the battery houses, remove chickens so that they can actually continue to grow and that action of going in and out is cross contaminate. The guys carry in on their boots to the next place. You get this cross contamination. When you get into the advert of our system you’ve got a problem because all the chickens are going through and it’s lots of water and intestines and it just cross contaminates so it gets very hard then to actually control it going through. But there are some production processes which they’re trying to develop which would actually minimize it like and not thinning is seen as being one. There are practice you can do ex-post, after slaughter which can get rid of it so freezing it, freezing chicken kills it but that would mean that every if you implement you would have no fresh chicken in supermarkets. It would all be Frozen, either frozen defrosted so you then can’t refreeze again or just frozen. Irradiation kills it but there’s a version too. So there are practices you can put in place. Now trimming neck skins off chickens, that’s an area where there’s high concentration so we trim the neck skin off the chicken, that reduces it but doesn’t get rid of it completely. So it is really difficult to actually eliminate it completely. They’ve got it down now to 50% of chickens now have got in the UK are down to having the load and they’ve have the number who’ve got the really high level from about nine to about 5% have got really high levels. So there’s some practices you can put in place but it seems to be really quite difficult to eliminate completely. Cook it, it’s a simple recommendation because that does get just get rid of it. But you want that chicken burgers. Thank you.

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