Lingering fear and questions

After more than six weeks, the story surrounding the nation's largest pet-food recall still doesn't have an ending.

Instead, the drama is intensifying, with new recalls pushing the total to well beyond 100 brands and developments occurring on other fronts almost daily.

At press time, the Food and Drug Administration (FDA) announced that melamine-tainted pet food, used as salvage, was fed to hogs in California, New York, North Carolina, South Caroline, Utah and possibly Ohio. The impact to food safety was under investigation by federal regulators.

Meanwhile, lawmakers in both houses of the U.S. Congress took an active role during two key hearings, performing their own kind of necropsies on the situation to find out how events unfolded and how to improve safeguards.

The FDA also was investigating the possibility that pet-food ingredients imported from China might intentionally have been spiked with melamine (used in plastics and fertilizer) to make the foods' protein content appear greater.

For several weeks, wheat gluten was the only ingredient found to be tainted with melamine. Then it was learned that rice protein concentrate also was affected, spurring the sixth in a continuing series of recalls of several top brand-name products, both wet and dry varieties.

The FDA, the American Veterinary Medical Association (AVMA) and the American Society for the Prevention of Cruelty to Animals (ASPCA) all regularly update the lists of recalled products on their Web sites, and information also is posted on the manufacturers' Web sites.

For a time, the fallout that spread rapidly after the initial March 16 recall seemed to have peaked – veterinarians were getting fewer calls from anxious clients and the number of new cases of pet renal failure and deaths seemed to have leveled off.

But it soon became clear that the drama is far from over. Here are other reasons why:

• The string of recalls after the original recall of 95 products manufactured by Ontario-based Menu Foods Inc. leads many to ask: How far will it go?

• News that tainted food was shipped to hog farms raises questions about whether the human food supply was affected. Dr. Stephen Sundlof, director of the FDA's Center for Veterinary Medicine, told reporters at a teleconference that "hogs that have been fed salvage pet food in North Carolina, South Carolina and California were tested, and levels of melamine were detected in their urine." Sundlof said it wasn't yet known whether contaminated meat entered the food supply, but that all hogs at the farms were quarantined.

• The FDA advised pet owners as late as mid-April that some of the tainted food might still be on store shelves despite its best efforts to remove it. "We do believe we've got the vast, vast majority off the market," Sundlof told the Senate Agriculture Appropriations subcommittee in a hearing April 12. Later, he said his office still couldn't issue an all-clear.

• In the wake of that hearing, a subcommittee of the House Energy and Commerce Committee, at an April 24 hearing, expressed concern about the safety of both human and animal foods. "What has the FDA done to prevent food-borne illnesses? It appears the FDA has decided to centralize food-safety decision making in Washington, D.C., cut back on inspections, and hope that food producers and manufacturers will self-police their industry based on voluntary guidelines," said U. S. Rep. Bart Stupak, D-Mich., chairman of the of the Oversight and Investigations Subcommittee. Other panelists raised concerns about imported ingredients, especially from China, source of the melamine-tainted products.

• While melamine was identified as the main contaminant, the underlying causative toxin remains unknown, leaving some veterinarians concerned that pets recovering from acute renal failure might suffer chronic problems with kidneys or other organs in the future.

• Legal issues arising from pet deaths and possible regulatory changes in the pet-food industry to prevent future large-scale recalls are certain to keep the crisis front and center for some time to come.

• The problem now extends outside the United States: At press time, 30 dogs reportedly died in South Africa, where a third ingredient, corn gluten, was contaminated with melamine. (No tainted corn gluten was found in the United States.) Two food-related deaths of dogs were reported in Puerto Rico. And the Canadian government asked the Canadian Food Inspection Agency to review whether pet food in that country should be regulated. The agency will recommend various actions the government can take, including regulation, to better monitor the safety of pet foods.

The congressional sidebar: Sens. Richard Durbin (D-IL) (left) and Herbert Kohl (D-WI) confer during a Senate hearing on the pet-food recall. (See related story.)

Long-term effects

Among those expressing concern about possible long-term effects of tainted foods is Dr. Nancy Zimmerman, senior medical adviser for Banfield, The Pet Hospital, which is assisting the FDA investigation through its extensive database that gathers information from more than 615 Banfield pet hospitals nationwide.

"Until we have identified the true toxin that caused acute renal failure, particularly in cats, no one can say what might happen in the long term, whether this (renal failure) could become chronic, or whether more organs might become involved," Zimmerman says.

"While it's true that we're seeing fewer new cases and not as many calls – it seems we've hit a plateau there – this hasn't gone away. Right now, many of the pets we saw during the first week or two are coming back for follow-up care."

At New York City's Animal Medical Center, Dr. Cathy Langston, DVM, Dipl. ACVIM, says new cases there also seem to have leveled off, but that she, too, has concerns about potential future effects of the tainted food.

"We have not hospitalized a patient for renal failure induced by the food in over a week (first week of April), and I don't know of any pets that were diagnosed with renal failure from the food as an outpatient in the past week," Langston says."Because a large percentage of patients developing acute kidney failure are left with chronic kidney failure, I am worried about the long-term effects on the renal health of our patients. "However, since the vast majority of these patients have survived the initial injury in contrast to the 50 percent death rate associated with most causes of renal failure, I remain hopeful that this injury is less severe in general and perhaps that will translate into less chronic damage."

The changing scenario and spotty information about what foods are safe left millions of pet owners confused. Some filed private lawsuits or began to join class-action suits over pet deaths.

Numbers game

Estimates of the number of pet deaths and illnesses vary widely. The true number may never be known. Cases in point:

At press time, the online network petconnection.com reported more than 4,100 deaths and 12,000 sickened pets, based on its survey.

The Veterinary Information Network (VIN) said 1,000 to 10,000 pets may have been sickened, with a possible 30 percent death loss, based on a survey of 1,415 DVMs among its membership.

However, VIN founder Paul Pion says those numbers are estimates only. "Nobody is ever going to know the truth." (See related story)

The confusion among pet owners is reflected in calls received at companion-animal clinics around the country.

"People don't know what to do. They're asking what foods are safe. We mainly refer them to the Web site or 800 number," says a receptionist at West Lake Animal Hospital in Springfield, Ill. "We've had no pets die from the food. Our clients returned all the dry cat food that was recalled."

At the Animal Medical Center of Chicago, a spokesman reports "a lot of calls came in, maybe up to 200, from people wondering what to do if their animal shows symptoms, what's safe to feed. We had one cat death related to the recalled food."

A spokeswoman at the Cat Care Clinic in Orange, Calif., told DVM Newsmagazine, "We ran lots of blood and urine tests, but found only one case of renal failure that might be related to the food recall. We had hundreds of calls at first. Not so many now, but it's clear that people are confused."

An avalanche of questions

Veterinarians remain on the front line as a source of information on what commercial foods are safe, or how to make nutritious foods at home for the growing number of clients who wish to do so.

The crisis kept AVMA busy, especially in the first couple of weeks after March 16. "We were here day and night and weekends for a while. It was like gangbusters," says David Kirkpatrick, media-relations (outreach) manager.

"There were literally hundreds of calls from veterinarians, the media, the public, state and federal officials, legislators. But it finally settled down, and I'd say there's more of a sense of calm now."

The ASPCA also fielded many questions, responding with a warning and some feeding advice.

Dr. Stephen Hansen, a toxicologist who manages the ASPCA's Poison Control Center in Urbana, Ill., says on the group's Web site, "We are far from sounding the all-clear and need to safeguard our pets' lives vigilantly."

The ASPCA recommends that owners not feed their pets anything containing wheat gluten or rice protein concentrate, saying "There are several high-quality foods available that do not contain these ingredients, so please ask your veterinarian for an alternative recommendation."

The nation's veterinary schools, too, were approached for answers that were in short supply.

As Sarah Carey, public-relations director at the University of Florida's College of Veterinary Medicine, recalls: "l considered putting together a question-and-answer handout for all the media inquiries we received, but then stopped and asked myself, 'why even try?' There are no answers right now. This story just keeps changing."

While answers might have been few, there were plenty of questions – not only about the real scope of the problem, but why safeguards didn't seem to work and what can be done to prevent a recurrence.

FDA's actions

Members of Congress were among those doing the asking, particularly at the April 12 Senate subcommittee hearing where Sundlof testified, along with two other regulatory officials and two veterinarians with experience in the pet-food industry. (See related story.)

Still more questions came from the media. At an April 5 teleconference, Sundlof made these key points in response to call-in inquiries from 16 reporters:

• The FDA began investigating within 24 hours after being notified of the initial Menu Foods recall.

• The FDA received more than 12,000 complaints in the three weeks after March 16 – more than twice the number it typically gets in a year on all consumer issues. By the third week of April, that number had grown to 14,000.

• More than 400 FDA employees in 20 regional offices are investigating.

• Because the recall involved about 1 percent of the total pet food supply in the United States, there is plenty of safe food left – 99 percent of it.

• The FDA could confirm only 16 pet deaths early on because of the tedious process of testing and obtaining results that positively link an animal's death to the recalled foods, but is aware that the true number of deaths and illnesses is much higher.

While melamine was found in tainted wheat gluten from a Chinese supplier (and later in rice protein concentrate), that chemical probably is not the causative agent but is a marker somehow associated with it. The search for the toxin goes on.

Where the multi-faceted investigation will lead no one at press time could say, but it is clear that veterinarians will continue to play a key role.

Besides the data that Banfield's doctors are providing the FDA, the AVMA urges its 30,000 companion-animal practitioners to participate in an online survey that will collect and distill critical information from case histories. (Details in story.)

Might anything positive result from the crisis?

Dr. Claudia A. Kirk, DVM, PhD, Dipl. ACVN, Dipl. ACVIM, associate professor in medicine and nutrition at the University of Tennessee and one of the two expert witnesses at the Senate hearing, hopes so.

One of her recommendations is for quicker and more centralized reporting in the event of future recalls.

The FDA relies on the Centers for Disease Control (CDC) to help track and quickly contain cases of foodborne illness in humans. Kirk would like to see something similar – an animal counterpart to the CDC.

She and other experts believe the current crisis just might be the catalyst for that to happen.