Mad cows and Englishmen: the aftermath of a BSE scare
Caroline Richmond
CMAJ 1997;156:1043-4
[ en bref ]
Caroline Richmond is a writer-editor living in London, England.
© 1997 Caroline Richmond
In brief
The consumption of prime beef cuts is down, animals have been slaughtered by the thousand and 3 farmers have committed suicide as the mad-cow issue continues to cause concern in the United Kingdom. In this report from London, Caroline Richmond also notes that the royal colleges have published a report stating that chronic fatigue syndrome is a real illness and patients need help.
En bref
La consommation de coupes de bœuf de choix est en chute libre, les bêtes ont été sacrifiées par milliers et trois fermiers se sont suicidés dans la foulée du problème de la vache folle qui préoccupe toujours le Royaume-Uni. Dans ce rapport de Londres, Caroline Richmond signale également que le Collège royal a publié un rapport déclarant que le syndrome de fatigue chronique est une maladie véritable et que les patients ont besoin d'aide.
Last September CMAJ published a review article[1] on bovine spongiform encephalopathy (BSE) and Creutzfeldt-Jakob disease (CJD), plus an accompanying editorial.[2] The articles described how a variant form of CJD has been recognized in 15 British patients and 1 patient in France. It is widely suspected that they contracted CJD by eating poor-quality beef products containing brain or tonsils from cows with BSE -- "mad cow disease" -- although 1 victim was a 23-year-old vegetarian.
The BSE scare has led to a mass avoidance of prime cuts of beef in the UK. According to the Hotel and Catering Federation, it also has led restaurant customers to avoid anything with the word "beef" in the title, although many will still order beef by other names when they call for sausages or burgers.
The facts: 55 people died of all forms of CJD in the United Kingdom in 1994, a number which has remained fairly constant for decades. That is about 1 person in a million, which in real terms is negligible. The disease has been recognized since 1920 and in recent years some people have contracted it from cadaver-derived human growth hormone. Today, the public at large believes that beef has been the vector for every case of CJD in the UK.
The scientific consensus is that BSE jumped the species barrier after cattle were fed mechanically recovered meat from sheep carcasses that, for a few years in the 1980s, had not been adequately sterilized. Mad-cow disease was first noted in the mid-1980s. By 1987 sterilization procedures involving their feed were identified as the cause, and temperatures were raised to the previous high levels. The incidence of BSE started to fall in 1991 and continues to wane; it is expected to be gone or almost gone by the year 2000. Last November the UK government decided to eliminate scrapie through the selective breeding of genetically resistant sheep.
People who want to reduce their risk of contracting CJD from diet are probably too late, as the danger period is over and the risk is now very low. Most of the affected cattle have been in dairy herds, which are more likely to receive feed supplements and to live long enough for the disease to become manifest. Beef cattle, which are slaughtered young, are used for the best cuts of meat, while older dairy cows are the source of hamburgers and sausages. This means that public avoidance of beef joints is almost pointless and illogical.
None of the physicians I know say they have been asked by patients if it is safe to eat beef; they admit that they still enjoy beef and, like most parents, give in to their children's demands for burgers. However, most schools have dropped beef from the dinner menu and supermarkets reported a dramatic fall in beef sales in 1996.
The declining demand has created a mountain of beef, some of which is being given to soup kitchens and organizations that feed the homeless. Down on the farm there has been a systematic slaughter of thousands of cattle over 30 months old, with the carcasses being incinerated. This is solely to restore public confidence in beef -- the British Veterinary Association has compared the slaughter with witch-burning.
The media have had a field day looking for CJD patients, victims or family members. Since the diagnosis can only be made with certainty after biopsy or autopsy, this has meant seeking out anyone with an unexplained neurologic disease and henceforth describing them as "probable cases."
For an epidemic that has killed a handful of young people -- plus 3 farmers who have committed suicide -- the whole mad-cow matter would seem, in normal times, to have been blown out of proportion. However, these are not normal times, and this public panic seems destined to run on and on.
Understanding chronic fatigue
On a more optimistic note, the battle for a better understanding of chronic fatigue syndrome (CFS) seems almost won. This has been achieved by intelligent strategy from the royal colleges and by high-quality briefings organized by the Royal Society's program on the public understanding of science.
Last fall a joint report was published by the royal colleges of Physicians, Psychiatrists and General Practitioners, initiated by a request by the government's chief medical officer, Dr. Kenneth Calman. The gist of the report was that myalgic encephalomyelitis was a confusing name and should be dropped in favour of CFS.
The colleges called for an end to the debate on whether the illness was mental or physical, as it is both. Emotional state and beliefs could affect how long it lasts, and there is no specific diagnostic test to determine if it exists and no effective drug to fight it if it does. The colleges say the best treatments are a program involving a gradual increase in activity combined with cognitive behavioural therapy, since too much rest can lead to muscle wasting. The colleges reiterated that the disease is real and patients need help, and while patients are not responsible for their illness they can participate in their recovery.
The report was launched at a press conference where, for once, there was little disruption from the myalgic encephalomyelitis lobby, which has unpleasantly (and hence counterproductively) lobbied the media for years. The lobbyists, who for diplomatic reasons had received the report a day in advance, gave it a guarded welcome, although they were disappointed by the emphasis toward psychologic factors and away from viruses.
References
- MacKnight C, Rockwood K. Bovine spongiform encephalopathy and Creutzfeldt-Jakob disease: implications for physicians, CMAJ 1996;155:529-36.
- Dodelet V, Ricketts M, Cashman N. Emerging problems in prion disease. CMAJ 1996;155:549-51.
 |
Send a letter to the editor responding to this article
Envoyez une lettre à la rédaction au sujet de cet article |
Features