There are a lot of diseases out there you haven't heard of and most of them are things you don't want to get. One of them is a neurological autoimmune disease called chronic inflammatory demyelinating polyneuropathy (CIDP) where the body attacks the covering of nerve fibers and prevents impulse transmission. It produces paresthesias (tingling), numbness and weakness. If not treated early it can become debilitating and incapacitating. As I said, you don't want to get it.
But apparently CIPD is exactly what 11 workers at Quality Pork Products in Minneapolis did get. All worked at the "head table" in the company's slaughterhouse. What is life at the head table like?
In a rapid-fire process that is noisy, smelly and bloody, severed pigs' heads are cut up at the head table at a rate of more than 1,100 an hour. Workers slice off the cheek and snout meat, then insert a nozzle in the head and blast air inside until the light pink mush that is the brain tissue squirts out from the base of the skull.Kruse [a 37 year old worker for 15 years], whose job was to remove meat from the back of the animals' heads, said she doesn't recall any spray or mist from the de-braining. The head-table workers were protected by safety glasses, helmets, gloves and belly guards, but none wore anything over their mouths or noses, she said. (Minneapolis Star Tribune, hat tip Boingboing)
Other than the gruesome nature of the work, the striking thing about this description is the speed and intensity of the line. 1100 heads an hour for a work station of 11 means 100 heads an hour per worker or one every 36 seconds with no breaks. There are sharp knives, workers next to you and unrelenting pressure. In this case something, whether it is pig brain material or some agent, perhaps a virus or a prion, that is responsible for the CIPD. But there is no doubt this is a nasty occupational disease.
Today's slaughterhouse work hasn't moved far from the days of Upton Sinclair's descriptions in The Jungle (1906). Those of you who read Sinclair's novel (I own a rare first edition) will remember that it was about immigrant workers. Immigrants, documented and otherwise, are still employed in this dirty and dangerous business.
I wonder how many so concerned about the "immigration problem" are willing to take on their jobs.
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Clusters of rare diseases (CIPD is about 1-2 per 100,000, I believe) are always hard to sort out -- are they causally linked or just coincidence? In this case there's an exposure to a plausible biological mechanism, but that doesn't guarantee that it is a cause. The presence of an obvious mechanism, especially one as memorable as this, makes it easy to remember, even if it turns out to be wrong.
Remember the cluster of CJD that was tentatively linked to eating squirrel brains -- and that turned out to be purely coincidence, but how many people know of the followup compared to the original suggestion?
Not taking issue with the general point of your post, this is obviously a potentially hazardous situation, but unless there is a demonstrated link let's be open-minded and ready to recognize other options.
Ian: There are 11 cases in 8 months, all at the head table. The mathematical analysis of clusters is what I do for a living, but my expertise isn't needed here.
How could the owners of this plant or regulators or veterinarians allow air pressure to be used to remove brains?
This is a fascinating story.Unfortunate for those who are suffering, but fortunately, this episode is very unlikely to happen again because the market for pig brains is so small that it doesn't warrant the risks involved.
But I wonder what is really going on here? Anytime a disease is diagnosed which doesn't have a specific blood test, etc, I am always a bit of a sceptic. I have no doubt that there has been a cluster of symptoms which are extremely unlikely to be random, but is CIDP really what these people have? For that matter, is CIDP anything more than a group of symptoms which have been lumped together and just given a name? I'm not ready to jump on board this one. Maybe this is just a repetitive motion thing. Lots of questions...
There are 11 cases in 8 months, all at the head table. The mathematical analysis of clusters is what I do for a living, but my expertise isn't needed here.
And there were five cases of CJD, a much rarer disease than CIDP, associated with people eating squirrel brains, in a clinic in Western Kentucky -- a cluster that is now believed to be coincidental.
I think it's very likely that there's a causal relationship. But I would like to see a formal link.
gary: Here's a link on the clinical work-up of CIDP. Decide for yourself.
Ian: What would you take to be a "formal link"?
Ian - clinic-based disease clusters are a very different entity, from the analytic perspective, than occupational clusters.
If you wanted an official citation direct from the state health officials, it can be found here:
http://www.health.state.mn.us/news/pressrel/qpp120307.html
The gang over at ProMED-mail is on the job, too:
http://tinyurl.com/2yjgfo
(Or, if you like doing your own searches, the archive number is 20071204.3915)
Gosh. Slaughterhouses are still bad news after all these years. So are canneries, especially for fish and meat products. I think that probably the gathering of animals from all around the globe into one common processing area, in combination with the requisite high-speed semi-mechanized processing equipment, produces new workplace hazards that need to be addressed today just as did crowding, impeded fire exits, open machinery, etc. as injury risks in the early part of the twentieth century. Not that any of those risks have gone away - but the 21st century high-speed processing plant has added a whole new layer of risk for both the worker and the consumer.
What would you take to be a "formal link"?
jen_m: Thanks for the pointer to the ProMED discussion (I used to subscribe to ProMED, but it's probably been 10 years since I read it regularly).
Here is the first thing I'd like to emphasize, from the ProMED team:
"The variety of sources of information
included in the posting above give a somewhat uniform picture of the clinical presentation -- muscular weakness and sensory deficits, with 5 of the 11 cases meeting the criteria for a diagnosis of chronic inflammatory demyelinating polyneuropathy ... "
One of the concerns I have with clinical clusters is that even skilled and well-trained people are prone to lump together diseases that are not the same. For example, here we started out with But apparently CIPD is exactly what 11 workers at Quality Pork Products in Minneapolis did get. That seems to be, at best, uncertain as yet.
So one thing I'd like, in terms of a formal link, is to be sure that these are all the same, or a related, disease.
As far as other ways of formal linkage -- the ProMED article jen_m points to lists a number of concerns. Quoting --
"There is always the chance that a low frequency event affecting a number of people is found when a subset
of them are noted and then investigations target in on that now visible handful, ignorant of the greater but spatially diluted number elsewhere;
- Slaughter houses are well known for attracting specific ethnic groups [...]. This cluster may just reflect a
coincidental genetically high risk group.
- Noting when it started and the latitude, could it not be an odd response to a normal seasonal problem, like, say 'flu?
- If it were specific to hog brains, we would expect to have seen this before and more widely ... unless this method of extracting brains is only a few years old ... "
And several other points.
Again: This certainly looks suspicious. But when revere says "His expertise isn't needed here", I think he's underestimating himself. Ignoring other possibilities, and focusing on a single possibility, isn't doing any favors to the victoms, or to other people potentially at risk.
I wonder how many so concerned about the "immigration problem" are willing to take on their job.
Revere quotes Sinclair's The Jungle as though nothing changed between then and now.
In fact, a great deal changed. From the 1940s through as recently as the 1970s, meatpacking was a largely unionized profession, and people who worked in packing plants were solidly middle class. Many of them became homeowners or sent kids to college on their pay, or both. They had solid health insurance which actually paid the doctor.
There were workplace safety standards which were adhered to by management because there was a government which actually sent inspectors around to enforce the standards, and imposed nontrivial fines on those operations found to be in breach.
Lines did not run at unsafe speeds, and when and where they did, unions would down tools and leave the workplace.
The work was still bloody, and still physically exhausting, and not socially prestigious, but people opted to do it, because it paid.
Employers *hated* this state of affairs. Because that pay came out of profits.
The first step in their counteroffensive was to move plants into "right to work" states. (A concept which had not previously existed in law until corporations bought enough political influence to get it in there.)
Then the immigration boom began, really becoming noticeable from the early 1980s onward. One enabled in part by the immigration "reforms" of 1965, and also in part by a government which found it convenient to look the other way on border policing, at the behest of the private interests which found it profitable to employ illegals.
Can't beat a workforce which is desperate. Wages fell, then fell further, then further still. Benefits disappeared. Unions vanished. It got to where even citizens in the "right to work" states refused the wage, and the job got to where it was staffed almost exclusively by illegals, and employers began to specifically (and illegally themselves) recruit the same.
I keep having to explain the following point, which is odd, because it's not rocket science. Labor markets are, at the end of the day, just markets. In a competitive market, when there is an excess of supply over demand, prices fall. And in a labor market, prices are wages.
How do you win a race to the bottom?
Trick question. The way to win is not to enter the race.
--
Oh, an addendum. I know a gentleman who was a union attorney and labor negotiator during the 1970s (not in meatpacking, but similarly rough blue collar). He recalls having thought at the time, "Whew, this is rough, the company is really playing for keeps," but he figured that it was part of an ongoing up and down historical cycle for the labor movement and that things would get better in a few short years.
He had no idea at the time that instead of up and down, that it was going to be down, down and down, and they were on what would turn out to be a continuing downslope lasting for decades.
--
Hormel was / is a union busting outfit. National Guard was called in after scabs were hired.
Thanks, marquer, for that post. Truth be told, any job can be made "a job no American wants". Those of us opposed to illegal immigration because of the abuse and exploitation of workers by corporations and the backwards slide in hard-won workers' rights, are made to look inhumane and ungrateful for the work done by exploited immigrants. On the contrary, it is the supporters of this policy of exploitation who have been duped while the corporatists laugh all the way to the bank.
- Slaughter houses are well known for attracting specific ethnic groups. This cluster may just reflect a coincidental genetically high risk group.
I can't give you a link, but I read it in the dead tree edition of the Strib; the set of symptoms were present across race, sex, gender and age.
One thing that I think is interesting about this is that CIDP is the chronic form of Guillain-Barré syndrome which came into prominence after the swine flu vaccine in 1976.
The Minnesota Department of Health is now saying that it isn't CIDP exactly, but the mechanism is the same. The myelin sheath is under attack from the immune system.
Beth: A reader (h/t KH) sent me the link from the Star Tribune which I read but when I went back to clip it for a post it was suddenly subscription only. So this remains a cluster of occupational neurological illness but not CIDP. The compressed air operation is still the suspected culprit but so far the disease, cause and proper treatment are unknown.
In my comment above I expressed scepticism about this being CCCP,and it seems that I was right. I am not a scientist, but just a layman with a healthy dose of scepticism.
I have a very keen interest in science, and love to read articles about it. I have learned from long sad experience, however, that much of what I read is imaccurate. For that reason I have tried over the years to develop a method of filtering out the bad stuff. One ofthe techniques I use is the old principle that extraordinary claims require extraordinary proof.
In this case I saw what I thought was an extraordinary claim.
I have enjoyed this blog whenever I have come here, and hope you will keep up the good work.
Cheers
Sorry, I meant CIDP, not CCCP.
Cheers
Gary: I don't think you quite understand what was being said or how disease outbreak investigations work. One of the first steps is to verify the diagnosis and in this case the question of CIDP is still up in the air or in doubt. But the common syndrome seems to be clearly accepted. If they all came down with a respiratory disease that was thought to be flu and on further investigation was not flu but something else (maybe identified and maybe not) it would still constitute a cluster of respiratory disease. Scientists, especially epidemiologists, are taught to be skeptical as a reflex but we are also aware there is inappropriate skepticism. This is a cluster of occupational disease. We'll have to see what label is finally put on it (it may be a previously unknown malady) but there seems little doubt that this is work related, whatever it is. And that was the point of the post and of the investigation. You have somehow fastened on the label and taken your eye off the main objective.
Part of the reason I find this outbreak unusual is that you might reasonably expect an excess of peripheral nerve disease among head table workers, given the vibratory equipment, but an autoimmune demyelinating disease is pretty unexpected. I can understand Gary and Ian's reserving judgment, especially given the usually low quality of newspaper outbreak reports.
Not to make Gary feel picked on, because anyone could have said it, but this is a misapprehension: "...fortunately, this episode is very unlikely to happen again because the market for pig brains is so small that it doesn't warrant the risks involved." The pig brains are removed secondary to preparation of snout and cheek meat for processing. Those meats are used in many commercial hot dogs, balogna, and sausages, so removing the brains is a pretty much universal step in pork processing. From what Tom said, it doesn't sound like every slaughterhouse uses high-pressure air or water jets to remove porcine brain tissue? (I am pretty sure it's not permitted with beef carcasses since the nv-CJD business.)
Actually, I wasn't disagreeing that there might be a common disease. It seemed to me that it almost certainly wasn't a random thing. I just thought the press had gotten ahead of the story, and I still think so. I think there was a rush to judgement. That often happens in the press. In no way am I criticizing the scientists involved in this matter or anyone who writes for this blog. I love Scienceblogs. It is one of the few places I can find legitimate science stories without the distortion and hype I find so often in the general press.
By the way, thanks for the link on CIDP you gave above. I read the whole thing. I once knew someone very well who died from MS, and I found the similarities to CIDP very striking. Scary stuff indeed.
This is another reason to stop illegal immigration. CIDP has no directly known cause, but its reasonable to assume that disease could play a large part in it. One guy carries a disease into the plant and gives it to someone else and then sets the stage for 11 people. Could it be atomized pig/horse/cow brains and blood in the atmosphere giving people something that facillitates the disease? Sure, but slaughterhouses are full of illegals of all sorts of nations now. It doesnt take a crystal ball to figure out that first something should be done at the head of the table, second to do something in the front office.
The one way to ensure that wages stay high in the US and that people who "wouldnt do the job" will is to make it worth their while. Unions helped in this but then they went overboard and started working for themselves as a collective bargaining corporation rather than a collective barganing agent for their people.
This is a micro examination of a macro problem. People are ill and thats a given. There is nothing thats going to change that except a full blown mindset in the US that starts acting in our national interests rather than that of the rest of the world. That doesnt just mean the Republicans, the Democrats too. We have politically corrected just about every issue in the US and become pretty much laughing stocks in the far east where they would take Revere out and shoot or imprison him for making "false statements". The workers would be hospitalized and later they would die of their ailments having put out the word that they all had AIDS/HIV. Finally, they would require a production increase to make up for the numbers lost from the workers not being there.
No simple answers to this. The only reason they arent taking over the meat processing is that it doesnt stay fresh enough to transport to the US.
Revere,
I can't locate this anywhere in the thread, but did they run nerve conduction velocity tests and do nerve biopsies on the patients? Or spinal fluid tests? Just wondering.
This story is very interesting to me, since I have had some type of peripheral neuropathy for the last 10 years. It came on after I had a typical winter bug, no clue what is was but at one point I could barely get to my feet after lying down. 2 weeks later pins and needles, vision problems, weakness, etc. Neurologist could not determine what was going on, so I just lived with it. What seemed to help was exercise and multivitamins, esp weight training. Still have residual effects but they are not too noticable.
CIPD sucks, big time. There really isn't a cure, some get better and some don't.
Probably there is some aspect of porcine CNS tissue that triggers the self-immune response, if they are right in the mechanism. Pretty sure mine was a result of a virus, I had a high fever and wicked-bad soreness during the original infection.
stu: Yes, I think they did nerve conduction, which is how they decided it wasn't CIPD (but I may be wrong; don't know where I read that). They still say it is a demyelinating process, though. And it's pretty surely a cluster of occupational illness.