Crohn's and the
A Perception of Risk
by Nicole Fréchette-Walrafen
When presented with evidence of possible risk to our health or to our environment, Canada like most modern nations, uses a process known as "Risk Assessment and Cost-Benefit Analysis" to guide its actions and decisions. This means that when evidence of a potential risk arises, the Government reviews the evidence, assesses the level of risk and then decides whether the benefits of action warrant the financial cost, even though that action may at times be necessary to determine whether the risk is in fact real. It is a Catch 22 situation that is directly responsible for the Mad Cow tragedy, the Tainted Blood scandal and a multitude of other crises that seem to plague our days. This method of managing our affairs constantly puts us in a position of putting out fires - of reacting after a crisis arises rather than acting with caution in order to prevent a crisis from occurring in the first place. It is a naïve and archaic throwback from simpler times and in the ever-increasing complexities of our modern world, Risk Assessment is no longer adequate and has in fact become dangerous. We can see the results of this Catch 22 in our seeming inability to deal effectively with any of the complex issues of our day. Consider environmental degradation, ozone depletion, nuclear wastes, our medical system crisis, the Walkerton tragedy, some 300 allowed and mostly untested food additives, the drug wars, pesticides, Frankenfoods and the list goes on forever. Progress has always been a double-edged sword. For the first time in human history, we have the potential to make decisions today that will not only affect our personal lives but will in all likelihood change the face of our planet and maybe even life as we know it. Perhaps it would be wise if along with our technological advances, we also endeavoured to develop more applicable and prudent principles to help guide our actions and decisions.
The Precautionary Principle is such a development. A bold new principle to guide human affairs into the 21st century, it is being acclaimed worldwide as the long overdue model to assist us in meeting the challenges of a modern age. It states: "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." The meaning of this statement is simple and yet exquisite. It says to err on the side of caution when there is evidence suggesting a risk, even if proof of that risk is not yet conclusive. The modern world is finally recognising that our current practices of risk assessment, which all too often translate into "If we can't see the harm, even if we're not looking very hard, there must be no harm", are no longer adequate. The Precautionary Principle says that governments and businesses have an obligation to take action to prevent harm even when conclusive proof of that harm is still uncertain. This action includes financial responsibility and a duty to actively investigate, understand, inform and act. It gives power to the people by making the perception of risk rather than the proof of risk, the trigger for invoking the Precautionary Principle.
Described by Dr. Crohn as a Frankenstein Monster and by some modern scientists as the human plague of the 21st century, Crohn's disease is a brutal and incurable inflammation of the intestinal tract. Its victims suffer from acute abdominal pain, severe diarrhoea, bleeding, ulceration and excessive weight loss that can become so severe as to transform vibrant young persons into skeletal shadows of their former selves. The director of the US Crohn's/Colitis Foundation compares it to having the worst stomach flu ever, that just never goes away. An estimated 4 million young people worldwide suffer from Crohn's disease and the incidence appears to be rising at an alarming rate, particularly in children. To this day, the cause remains elusive. Canada has the honour of having the highest incidence of Crohn's disease in the world with Manitoba topping all with a prevalence rate of 200 per 100,000 population. This incidence is higher than multiple sclerosis, muscular dystrophy and Huntington's disease combined and compares with the incidence of Juvenile Diabetes. Dr. Charles Bernstein of the University of Manitoba recently released statistics suggesting that this exceptionally high prevalence rate will likely be reflected across Canada and not just in Manitoba as was originally believed.
Since first described in 1913 by Scottish surgeon Dr Dalziel, Crohn's has been associated with a disease of cattle called Johne's (pronounced Yo-neez). Johne's disease is a severe intestinal infection caused by the bacterium Paratuberculosis, a cousin of tuberculosis and leprosy, which means literally "tuberculosis-like". Originally specific to cattle, Paratuberculosis (Map for short) has since spread to sheep, pigs, horses, goats, dogs, deer, rabbits, and bison to name just a few but more importantly, to 4 species of sub-human primates. This organism quite obviously has a far broader host range than was recognized in the past. In fact, we humans appear to be the only species allegedly still immune to this bug. Cows with Johne's suffer from severe intestinal inflammation that so closely resembles Crohn's disease that Dr Dalziel felt justified in proposing that the 2 diseases may in fact be the same. An estimated 20-40% of US dairy herds are infected with Paratuberculosis. Although a similar picture has always been reported for Canada, Dr. John Kellar of the Food Inspection Agency stated in a recent CTV news report that in fact an estimated 72% of dairy herds are infected with Paratuberculosis in some parts of Canada. According to Dr Gerald Ollis of the University of Alberta, sick animals can shed an estimated 500 billion Paratuberculosis organisms per day. These bacteria most certainly contaminate soil and water supplies. It is common practice to use manure as fertiliser and inevitably, some of that manure will be contaminated with Map which will inadvertently be spread to food crops. Terminally ill cows, their bodies dripping with bacteria, are destroyed and sent to rendering plants where they are turned into food pellets to feed other animals including farm fish and even our own pets. Even more alarming is that infected animals can shed bacteria for many years before showing signs of the disease, years during which an unknowing public will be consuming their milk. Inconceivable as it may seem, present regulations even permit end-stage animals to be slaughtered straight into ground beef for human consumption.
Despite many setbacks and severely underfunded research, the body of scientific evidence linking these 2 diseases continues to grow. Map has been isolated and cultured from intestinal tissues of Crohn's patients in the US, Australia, the Netherlands and France as well as from the breast milk of 2 Crohn's mothers. Using leading-edge genetic technology, the presence of Map has been detected in inflamed tissues of an estimated 65% of Crohn's patients tested. In all cases where Map has been associated with human disease, the strain of Map has been confirmed as bovine (cattle). Five (5) major international studies as well as tests presently being performed at Guelph University in Ontario, have confirmed the presence of viable Map bacteria in sample of retail pasteurized milk. Preliminary data also suggests that Map can survive water purification systems including chlorination and filtration.
Recent extensive reviews of the evidence by the European Commission and by the British Food Standard Agency concluded that there is sufficient cause for concern. They recommended urgent action be taken to determine what the evidence actually means and to obtain as quickly and efficiently as possible, the data necessary to reach more solid conclusions. Using the Precautionary Principle, the British Food Standard Agency urges the following recommendations:
1. Thorough examination of the geographical distribution of Johne's disease and Crohn's disease so that evidence of a common cause can be assessed.
2. Funding and research on improving safety of pasteurisation.
3. Improving information on the spread of Johne's disease in animals.
4. Improving information on the extent of Crohn's disease in humans.
5. Research on how humans respond to being exposed to Paratuberculosis.
6. Increasing education and training of all groups involved in dairy food production, on ways of minimising the spread of this infection.
7. Open meeting on the issues to inform the public as fully as possible about this complex issue.
Health Canada has been aware of the evidence linking Crohn's disease to dairy products for at least 7 years. In 1994, the Food Risk Agency of Health Canada drew up an internal document that was stamped: "Protected - Not for Distribution". In the document, there was question of Paratuberculosis as possible cause of Crohn's disease and milk as possible method of transmission and cause for concern for public health. The Government of Canada assessed the risk and then concluded even in the face of disturbing evidence, that it was and remains insufficient to warrant further action. But this assessment of insufficient risk is being arrived at without actively seeking answers. Information that could give conclusive answers can only be obtained by following the recommendations of the British Food Standard Agency, something Canada has not and is not doing. And finally, our government has NOT made the information public. On the contrary, it has suppressed information under the stamp of "Protected - Not for Distribution". Seven long years after the original Risk Assessment document and as thousands more young Canadians have fallen prey to this terrible disease, Canada continues to monitor world research and do precious little to actively seek answers. In autumn 2000, a proposal to make Johne's a reportable disease in order to assess its prevalence and distribution was rejected. And so once again, a bacterium that is extremely difficult to culture and that is known to be more difficult to kill than TB is being allowed to spread unmonitored, uncontrolled and ignored.
Scientists estimate that a meager 0.4 percent of all living species of bacteria and only a few % of pathogens (disease causing) have been identified. This incredible level of ignorance should evoke in all of us a deep sense of humility and should remain foremost in our mind when we make categorical decisions that chronic diseases must be hereditary or "multifactorial" just because we cannot readily discover their cause. We, as Canadian citizens and Crohn's sufferers, have a perception of risk that Crohn's disease is caused by consumption of water and food contaminated by Paratuberculosis and we hereby invoke the Precautionary Principle. There is no question that Map is present in our food and water. Because it has been ignored for a century, Map has spread unchecked across most of the Western world and has undoubtedly spilled over to the human community. Scientific evidence shows clearly that wherever this organism becomes established, we find a severe chronic and usually fatal disease of the intestines that has striking similarities to Crohn's disease. The Precautionary Principle states that it is not up to Canadian citizens to prove that Paratuberculosis dose pose a significant threat to human health but to the Canadian Government to prove that it does not. A lack of conclusive proof does not equal a lack of evidence.
We urge the Government of Canada to live by the Precautionary Principle in acknowledging its duty to actively investigate, understand, inform and act. The recommendations of the European Commission and the British Food Standard Agency listed above are the goals and the mission of Map-Canada. We ask only what is our right as Canadian citizens ~ the right to safe food and safe water. Canada has been monitoring the situation for many years. Nature created the Frankenstein Monster but human apathy and fear feeds its voracious appetite for victims. As a compassionate society, let us finally assure the thousands of Canadians who suffer this brutal affliction in silence, that Canada has the will and the courage to face the monster. After almost a hundred years, now is the time for action.