CJD risk 'is trebled by eating beef regularly'
Mystery deepens on report itself
CJD epidemiology sub-group announced
Maff's real agenda with subcommittee
EU warns Britain on illegal beef sales
Health, animal welfare boost vegetarians in Britain
September 16 1997 The Times BY IAN MURRAY, Medical correspondentEATING beef regularly appears to have trebled the risk of catching Creutzfeldt-Jakob disease, according to the fifth annual survey by the specialist unit in Edinburgh set up to monitor the illness. Those eating brains even very occasionally ran a fourfold higher risk of catching the disease.
The report is the first since the new variant of the illness was identified but it found no convincing evidence of specific dietary risk factors. The unit nevertheless agrees that the most plausible explanation of the new variant is exposure to "mad cow" disease before the introduction of the offal ban in 1989. Publication of the report coincided with the creation of a special epidemiology group, chaired by Peter Smith of the London School of Hygiene and Tropical Medicine, to consider the data on the new variant and to spot emerging trends.
The report is based on a study of the eating habits of the 187 cases of classic CJD [sporadic CJD, not nvCJD] identified between 1990 and 1996. The findings show that there was almost a threefold increase in risk associated with consuming beef every month and a 3.3-fold increase among those eating it weekly. There had been suspicion about the risks from eating lamb and the study found some people eating the meat on a monthly basis appeared to be at increased risk compared with those eating it less often. The difference is so slight that the link between the disease and the meat cannot be clearly shown.
The authors say the incidence of the illness increased from an average 24.8 cases a year before the BSE epidemic in 1984 to 34.5 between 1990 and 1996. Levels in Britain were comparable to those elsewhere in the world, including countries free of BSE.
An expert panel has been set up to weigh the risk of an emerging epidemic of the new variant Creutzfeldt-Jakob disease, the British Government said yesterday.
Sir Kenneth Calman, Chief Medical Officer, announced the formation of a sub-group of the Spongiform Encephalopathy Advisory Committee to review data on nvCJD and to spot emerging trends.The special epidemiology group will be chaired by Peter Smith of the London School of Hygiene and Tropical Medicine.
Listserve commentary 16 Sept 97The Times report refers to the fifth Annual Report of CJDSU, which is presumably available from the Stationery Office. The only Annual Report on the CJDSU Web site is that of 1995 (!!!) which is not much help. There is, however, a news release about the new report from the UK Department of Health news release page .
The news release says the report covers the period from May 1990, when the Unit was set up, to the end of April 1996, and provides information on the incidence of CJD in the UK during that time. Apparently April 1996 is not a typo. The Fourth Annual Report, which is on the CJDSU home page, was issued in August 1995 and covered the period to April 1995. So the information on this newly published report is seventeen months out of date.
Fiorst, though, re the Times report which was noted on BSE-L yesterday - quoting the CJDSU saying that those developing (the paper said "catching", which is a clue to how well-informed this wasn't) CJD appeared to have eaten beef and other meat products three times more than those who didn't.
Charles Arthur spoke today to James Ironside who said that (i) these results are ONLY for sporadic CJD victims - no nv-CJD cases were included in the study; (ii) though some of the results might appear to be statistically significant, realistically it's very hard to be sure what people actually ate, because you're interviewing their relatives; (iii) effect does not imply cause.
BMJ 1997 Aug 16;315(7105):389-395 Cousens SN, Zeidler M, Esmonde TF, Silva RD, Wilesmith JW, Smith PG, Will RGOBJECTIVE: To identify changes in the occurrence of Creutzfeldt-Jakob disease that might be related to the epidemic of bovine spongiform encephalopathy. DESIGN: Epidemiological surveillance of the United Kingdom population for Creutzfeldt-Jakob disease based on (a) referral of suspected cases by neurologists, neuropathologists, and neurophysiologists and (b) death certificates.
SETTING: England and Wales during 1970-84, and whole of the United Kingdom during 1985-96.
SUBJECTS: All 662 patients identified as sporadic cases of Creutzfeldt-Jakob disease.
MAIN OUTCOME MEASURES: Age distribution of patients, age specific time trends of disease, occupational exposure to cattle, potential exposure to causative agent of bovine spongiform encephalopathy. RESULTS: During 1970-96 there was an increase in the number of sporadic cases of Creutzfeldt-Jakob disease recorded yearly in England and Wales. The greatest increase was among people aged over 70. There was a statistically significant excess of cases among dairy farm workers and their spouses and among people at increased risk of contact with live cattle infected with bovine spongiform encephalopathy. During 1994-6 there were six deaths from sporadic Creutzfeldt-Jakob disease in the United Kingdom in patients aged under 30.
CONCLUSIONS: The increase in the incidence of sporadic Creutzfeldt-Jakob disease and the high incidence in dairy farmers in the United Kingdom may be unrelated to bovine spongiform encephalopathy. The most striking change in the pattern of Creutzfeldt-Jakob disease in the United Kingdom after the epidemic of bovine spongiform encephalopathy is provided by the incidence in a group of exceptionally young patients with a consistent and unusual neuropathological profile. The outcome of mouse transmission studies and the future incidence of the disease in the United Kingdom and elsewhere, will be important in judging whether the agent causing bovine spongiform encephalopathy has infected humans.
DEPARTMENT OF HEALTH Monday 15th September 1997The Department of Health today published the fifth annual report of the National Creutzfeldt-Jakob Disease Surveillance Unit in Edinburgh.
The report covers the period from May 1990, when the Unit was set up, to the end of April 1996, and provides information on the incidence of CJD in the UK during that time. The report also provides analyses of data collected by the Unit on the dietary and occupational histories of patients.
The main findings of the report are:
* The major finding since the Unit's last report has been the identification of new variant CJD (nvCJD). The dietary history of nvCJD patients has not revealed any convincing evidence of specific dietary risk factors, but the report agrees with the Spongiform Encephalopathy Advisory Committee (SEAC) that the most plausible explanation for these cases is exposure to the BSE agent before the introduction of the specified bovine offals ban in 1989.
* There has been an increase in the number of cases of classic sporadic CJD recorded in England and Wales for the period 1970-April 1996, with the greatest increase in those over the age of 75 years. Substantial increases in the reported incidence of CJD have also been observed in other countries who monitor the disease, including those where BSE is rare or absent. These increases are most likely to reflect improved case ascertainment, especially in the older age groups, rather than a real increase in the disease.
* A study of the occupations of people with CJD shows no conclusive evidence of a link between occupation and CJD, including new variant CJD. Although the incidence of classic sporadic CJD amongst farmers, including dairy farmers, in the UK is higher than for the general population, it is comparable with the incidence amongst dairy farmers in other European countries including those where BSE is rare. There are no farmers or farm workers among the cases of new variant CJD.
* Analysis of the dietary histories of people with classic sporadic CJD has revealed apparent associations between various meats and animal products and risk of CJD. These apparent associations must be treated with great caution because of the difficulties of obtaining accurate data and recall bias.
* There is no strong evidence of changes in the geographical distribution of CJD since the advent of BSE. Analysis of data shows no convincing evidence of space-time clustering of cases.
* The overall incidence of CJD in the UK remains comparable to other countries in Europe and elsewhere in the world, including countries which are free of BSE.
Monday 15th September 1997 Department of HealthSEAC sub-group to look at emerging trends in nvCJD
Sir Kenneth Calman, Chief Medical Officer, today announced the formation of a sub-group of the Spongiform Encephalopathy Advisory Committee (SEAC) to consider the epidemiological data on new variant CJD (nvCJD). The sub-group will keep this information under review so that any emerging trend in the incidence of nvCJD can be identified as soon as the data permits.
Sir Kenneth said:
"There is still a lot we do not know about this disease, including important information on the incubation period, the route of infection, the level of exposure required to cause disease and the role of genetic susceptibility. "With the agreement of its chairman Professor John Pattison, I have decided to set up a sub-group of SEAC to assess the information about the epidemiology of nvCJD and develop as far as possible advice on trends in the disease. "I am pleased that Professor Peter Smith has agreed to chair the sub-group which will report both to me and to SEAC."
1. The sub-group will be given the following remit: "To assess the information about the epidemiology of nvCJD and develop as far as possible advice on trends in the disease." 2. Professor Peter Smith is an epidemiologist from the London School of Hygiene and Tropical Medicine and a member of SEAC. Other members of the sub-group will be announced shortly.
Our London correspondent 16 Sept 97MAFF have admitted setting up a committee to try and estimate the size of any forthcoming CJD2 epidemic. Note that it is headed up by Prof Peter Smith who has been making some MAFF-alarming predictions of cases. Naturally, as head of a MAFF sub-committee he will no longer be commenting in public until a report is published, if it ever is. Effectively a thorn in MAFF's side has been silenced. This also reflects the new Government sensitivity to the media, it doesn't want bad news to come out without warning outside its control into the headlines, better to warm the public up for bad news before it emerges.
The Epidemiology Sub-Group included two other SEAC members, Dr Richard Kimberlin (SARDAS) and Professor Will Hueston (University of Maryland) plus the following non-SEAC epidemiologists:
Professor Roy Anderson (Oxford University), Professor Robert Curnow (Reading University), Dr Peter Goodfellow (SmithKline Beecham Pharmaceuticals), Professor Dr. Ir. Aalt Dijkhuizen (Wageningen Agricultural University) Professor Nicholas Day (Medical Research Council Biostatistics Unit), Dr John Williams (Roslin Institute), Dr Rosalind Ridley Cambridge University) and Mr John Wilesmith (Central Veterinary Laboratory) The Subcommittee was assisted by: Dr Sheila Gore (Medical Research Council Biostatistics Unit), Dr Neil Ferguson (Oxford University), Dr Christl Donnelly (Oxford University), Dr John Woolliams (Roslin Institute), and Ms Judith Ryan (Central Veterinary Laboratory)
Wed, 17 Sep 1997 posting
"Looking back, one of the fundamental mistakes that we made as a government was in the way we set up and used expert committees. An expert committee which consists only of experts is liable to many diseases, all of which I saw in action at MAFF:.
1) they tend to follow the scientific orthodoxy, and ignore or exclude dissent.I have urged that all such committees should have lay members, should be open to representations from others (to which they should publish detailed replies), and should feel as free to disagree in public as the Law Lords do. That sort of openness and participation is what this government claims to be about. I too shall study the makeup of the committee with interest."
2) they feel constrained to produce unanimous or consensus decisions, because that is what government has asked for
3)They don't talk to outsiders who have different backgrounds and experience, or who hold different views....except that the civil service get their oar in, of course, and so do the voices of the environments where the members od the commitee come from (usually industry and academia). The public and their pressure groups, justly, feel excluded.
4) they don't have enough experience of the real world to deal with situations into which that world intrudes
5) because they are expert and unanimous, they frighten ministers out of playing their proper role - taking the decisions.
September 17 1997 CHARLES BREMNER IN BRUSSELSTHE European Commission decided to start proceedings against Britain yesterday, over alleged breaches of the ban on beef exports. The action follows the discovery last spring that thousands of tonnes of British beef had been shipped abroad, mainly through Belgium and The Netherlands.
Under the rules of "infringement proceedings", the Commission will send Britain a letter stating the evidence that exports have taken place and warning it that it will face court proceedings if it fails to demonstrate that it has ended the alleged breaches.
News of the illegal exports inflicted fresh damage on the European beef industry in the early summer and stirred a new wave of anger against Britain as half a dozen countries outside Europe imposed new bans on beef from Continental countries.
The case is likely to stop well short of the European Court because the Government took swift steps to end the illegal trade. Jack Cunningham, the Agriculture Minister, closed meat plants suspected of shipping beef for export last July and he is seeking further powers from the House of Commons to crack down.
Dr Cunningham blamed lax controls by the Conservative Government for what he said was a sophisticated chain of fraud. The Tories had "wilfully" refused to introduce powers to stop exporters avoiding the ban, he said in July. The Commission's veterinary and consumer services must be convinced that the action is effective before calling off the proceedings.
The Government is to pay compensation of £90,000 to £140,000 to families of five people who died from Creutzfeldt-Jakob disease after receiving growth hormone treatment. The settlement was reached in the High Court, which ruled last year that the Department of Health was negligent in starting treatment on the five despite a warning that the hormone could be contaminated. A production method that kills the CJD agent has been developed.
By PATRICIA REANEY, Reuters September 10, 1997LEEDS, England - More Britons are giving up meat over concern about their health and the welfare of animals, a leading food consultant said Wednesday. Dr. David Baines, an independent consultant, told the British Association annual science conference that the number of vegetarians in Britain had doubled in recent decades. Vegetarians now made up eight percent of the population. In addition, half of the country's meat eaters had reduced their meat consumption, Baines said.
"The market for vegetarian foods, also referred to as meat-free and animal-free foods, is one of the fastest-growing sectors of the food industry," Baines said. He said the annual sales of the sector were estimated at $635 million.Advances in technology had made the so-called "veggie burger" tastier and easier to chew, helping to fuel a 139 percent increase in sales of non-meat burgers and sausages ovet the past five years, Baines said.
"Food sciences have moved forward," he said. "This growth (in demand) has fuelled investment in research in the food industry to develop new and improved ingredients specifically designed for vegetarian consumers."The biggest challenge facing the food industry had been to substitute meat with protein food products that look, taste and have the consistency of meat. Using a technique called electromyography, which measures chew characteristics, he said researchers had been able to produce meat substitutes with the same chew patterns as meat. And by combining proteins from soya, the most popular ingredient in meat substitutes, as well as peas and wheat gluten, food manufacturers had made products that have more protein and less fat than meat. Baines said fears sparked by the discovery last year that mad cow disease could apparently be transmitted to humans could only have added to the demand for alternative meat products.
"Health is the main concern," Baines said, explaining the trend away from meat. "Fat and animal welfare are the other key issues. The vegetarian market is expected to continue its dramatic growth over the forseeable future and this will generate further interest in developing new sources of plant proteins and innovative methods of converting these proteins into highly palatable food products. As the technology advances, textured proteins derived from plants will become increasingly more sophisticated, providing a sound nutritional and enjoyable alternative to meat," he said.