Letters

All milk products should be heat treated

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7038.1099b (Published 27 April 1996) Cite this as: BMJ 1996;312:1099
  1. D M Campbell,
  2. J M Cowden,
  3. G Morris,
  4. W J Reilly,
  5. S J O'Brien
  1. Consultant in public health medicine Consultant in public health medicine Consultant in environmental health Consultant in veterinary public health Consultant in public health medicine Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow G20 9NB

    EDITOR,—We support Anita Rampling's recommendation that pasteurisation should be the first stage in the production of all milk products.1 The European directive 92/46/EEC sets standards for raw milk, heat treated milk, and milk based products. While the directive sets microbiological criteria for certain milk based products, member states may grant derogations from the regulations. The enforcing Dairy Products (Hygiene) (Scotland) Regulations 1995 make it possible for “milk-based products with traditional characteristics” to be given a derogation. Such derogations are illogical and endanger public health.

    In Scotland the fitness of a batch of a particular cheese for human consumption has recently been tested in the courts.2 Listeria monocytogenes was identified in retail samples, and a condemnation order under section 9(6) of the Food Safety Act 1990 was sought. This was the only legislative route open to the enforcing authority as, though the cheese did not meet the terms of the directive, the regulations of 1995 were not then in place. The order was refused, the sheriff finding that “the evidence did not support the claim that all strains of L monocytogenes should be regarded as potentially dangerous—and hence, likely to be injurious to health.” If the presence of potentially pathogenic organisms in a cheese, determined by best professional advice, is not sufficient proof of a risk to health for legal purposes, where does this leave local authorities as enforcement agencies under the act, and health boards and health authorities as their medical advisers? Is the proof of human disease required before intervention can take place?

    While some pathogens are inactivated during the cheese making process, others survive or increase; whether they do so is determined by the microbiological, biochemical, and physical properties of the particular cheese. Thus the manufacturing process itself, despite the application of risk assessment, cannot be guaranteed to produce a product free of pathogens without prior pasteurisation. Cheeses, especially traditional cheeses, are often sold in outlets or restaurants where a health warning is impractical. Informed choice is therefore not possible. In Scotland pasteurisation of cows' milk that is for sale has been compulsory since 1983. Outbreaks associated with milk (other than those due to the failure of plant or avoidance of treatment) have ended. The present position places the public's health in jeopardy. Pasteurisation, or similar heat treatment, should be used for all milk products sold for human consumption, however produced.

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