As a parent, I try to avoid absolutes in raising my kids. While I have definite preferences about television watching and fast food and various other aspects of their care, sometimes a little wiggle room is necessary. I keep the “never ever” list pretty short. For example, my sons will never play tackle football (a topic for another time, perhaps). So long as I have any say about it, none of my kids will ever ride a motorcycle. And my children are never, ever to drink unpasteurized milk. Ever.
This prohibition probably doesn’t occur to most parents. Pasteurized milk is readily available, and the unpasteurized (or “raw”) variety isn’t something they’d even think to look for. Most states prohibit its sale in grocery stores, so avoiding it is a non-issue.
But some parents do seek it out, and there is a movement to make it widely available on supermarket shelves. Touting a variety of health benefits, proponents of unpasteurized milk consumption believe that the process of pasteurization (during which milk is heated to a high enough temperature to kill most harmful bacteria) robs it of enzymes and healthy bacteria. With the right information from purveyors about pasturing and hygiene, they maintain that consumers can avoid the health risks of drinking milk that hasn’t gone through this process.
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Unfortunately, those health risks are quite real, and they can be terrible. Numerous pathogens can be transmitted through consumption of unpasteurized milk, to which pregnant women and children are especially vulnerable, including Salmonella, Listeria, and a particularly dangerous strain of E. coli. From 1998 to 2011, the CDC documented nearly 150 outbreaks of illness caused by drinking raw milk, which sickened over 2,000 people.
I was finishing medical school at the early end of that time frame, so presumably the patient I saw that cemented the parenting prohibition in my mind is included in those numbers. He was on a high-frequency ventilator in the pediatric ICU with multi-system organ failure, which developed after he contracted hemolytic-uremic syndrome from drinking unpasteurized milk. Seeing the catastrophic effect of this illness on a previously well child made a lasting impact.
I never want that happening to my children or my patients.
However, unlike the anti-vaccine movement, which seeks to benefit from the health care decisions of others while simultaneously undermining them, the raw milk movement isn’t a threat to the community at large. The only people put at risk are the adults who choose to drink the milk themselves, or (more worrisomely) their children.
Furthermore, I can even accept a plausible rationale for their decision, as there is at least one study they can cite in support of the health benefits they attribute to it, which is in keeping with an emerging “hygiene hypothesis” that the rise in illnesses like asthma and eczema is due to decreased exposure to infectious agents within the developed world.
But just because I can understand the decision, doesn’t mean I think it’s safe. As the American Academy of Pediatrics points out, there is a large body of evidence that shows equivalent health benefits between pasteurized and unpasteurized milk. Much of the data raw milk advocates present about the health benefits of its consumption are ambiguous about where the purported benefits come from. It’s unclear whether it’s the milk alone, or the whole host of exposures that come from living on a farm that protect against certain illnesses.
What is unambiguous is the risk, which can be significant even if you know where the raw milk is coming from. Increased availability would quite plausibly lead to increased consumption, and with increased consumption would come higher incidence of foodborne illness. While I am generally in favor of letting people make bad risk-benefit calculations when it’s only their health on the line (bad health decisions that undermine the health of the community at large are a different story), the high likelihood of parents giving raw milk they purchased at the grocery store to their kids raises serious concerns. Should states allow the product to be sold in that setting, the bare minimum they should require is a clearly-worded warning label advising customers of the health risks.
For my family, however, the decision is easy. Unpasteurized milk is off the menu, and it always will be.
