From: Subject: Paratuberculosis And Crohn's Disease: Got Milk? Date: Wed, 16 Dec 2009 20:47:58 -0800 MIME-Version: 1.0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.mad-cow.org/00/paraTB.html X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 =EF=BB=BF Paratuberculosis And Crohn's Disease: Got = Milk?

Paratuberculosis And Crohn's Disease: Got Milk?

by Michael = Greger,=20 MD
Updated January 2001=20

Project Censored

Microbial foodborne illness is the largest class of emerging = infectious=20 diseases. In 1999, the Centers for Disease Control (CDC) released the = latest=20 figures on the incidence of US foodborne illness considered by the Food = and Drug=20 Administration (FDA) to be the most complete estimate ever compiled. = Seventy-six=20 million Americans every year get food poisoning, more than double the = previous=20 estimate. In today's food safety lottery there's a 1 in 4 chance you'll = get=20 sick, 1 in 840 chance you'll be hospitalized and 1 in 55,000 chance that = an=20 American will die from foodborne illness annually.[1] =

The CDC estimates 97% of foodborne illness is caused by animal = foods.[2] = The latest US=20 Department of Agriculture (USDA) survey, for example, found 9 out of 10=20 Thanksgiving turkeys--over 90%--are contaminated with campylobacter, the = most=20 common cause of bacterial food poisoning in the US.[3] = And 75% of=20 the turkeys are contaminated with two or more food-borne diseases, most = often=20 salmonella as well, which are becoming dangerously resistant to many of = our best=20 antibiotics.[4]

Although thousands die from food poisoning every year in the United = States,=20 most sufferers only experience acute self-limited episodes. Up to 15% of = those=20 that contract salmonella, however, go on to get serious joint = inflammation that=20 can last for years. An estimated 100,000 to 200,000 people suffer from = arthritis=20 arising directly from foodborne infections each year it the USA. = NAME=3D"fnB5"=20 HREF=3D"#fn5"[5]

The most feared complication of food poisoning, however, is = Guillain-Barre=20 syndrome, in which infection with campylobacter can lead to one being = paralyzed=20 for months on a ventilator. Up to 3800 cases of Guillain-Barre are = triggered by=20 infection with campylobacter every year in the US. NAME=3D"fnB6"=20 HREF=3D"#fn6"[6]

Some scientists now fear, though, that an even more serious disease = may be=20 contaminating our food supply. Often touted as the Pulitzer Prize of = alternative=20 journalism, a Project Censored Award was given to what was considered = one of the=20 most censored stories of 1999--the connection between Crohn's Disease = and=20 paratuberculosis bacteria in milk.[7] =

Crohn's Disease

Described as a human scourge,[8] = over a half=20 million[9]=20 Americans suffer from this devastating, lifelong condition[10] with=20 annual US medical costs in the billions.[11] Crohn's=20 sufferers experience profuse urgent diarrhea, nausea, vomiting, and = fevers.[12] Because of=20 the diarrhea, many people are unable to leave their houses; others drive = around=20 in recreational vehicles or mobile homes to keep a bathroom close at = hand.[13] The=20 director of the National Association for Colitis and Crohn's Disease = says the=20 best way to describe the disease to non-sufferers if to have them think = of the=20 worst stomach flu they ever had and then try to imagine living with that = every=20 day.[14]=20

What happens is that the immune system starts attacking the lining of = the=20 gut, which becomes swollen and inflamed.[15] In extreme=20 cases this painful embarrassing condition can affect any part of the = digestive=20 system from the mouth to the anus.[16] This=20 inflammation narrows the digestive tract and can result in excruciating = pain=20 during digestion as well as constant uncontrollable bowel movements. = Added=20 discomforts associated with Crohn's disease include severe joint pains, = weight=20 loss and lack of energy.[17]

The intestines characteristically become so deeply ulcerated that = they take=20 on a "cobblestone" appearance. The ulcers can actually eat right through = the gut=20 wall and cause bleeding, abscesses, fistulas and perforation.[18] Passing=20 food, sometimes even just drink, through Crohn's damaged intestines can = be=20 excruciatingly painful. In the words of one colon-rectal surgeon, = "Crohn's is a=20 surgical disease. We wait until the patient can no longer withstand the = pain=20 anymore, and then we perform surgery=EF=BF=BDand repeated surgeries over = time=EF=BF=BDultimately, as recurrences happen and intestinal damage = occurs, we just cut=20 and cut, in some cases, until there is no more intestine that can be cut = out."[19]

Tragically, Crohn's disease typically strikes people in their teens = and early=20 twenties--destroying their health.[20] Children,=20 adolescents, and young adults suddenly become faced with the harsh = reality of a=20 lifetime of chronic pain, in and out of hospitals their entire lives.[21]

The disease is mostly found in the US, UK and Scandinavia.[22] And it's=20 on the increase. The incidence in the US, which has been increasing = steadily=20 since the 1940's--doubling, then tripling, then quadrupling[23]--is now=20 approaching that of an epidemic.[24] The most=20 rapid increase has been seen in children. In the 1940's and early 1950's = there=20 were no recorded cases of Crohn's in teenagers. Currently one in every = six new=20 cases diagnosed are under age twenty.[25] Dr. Crohn,=20 who described one of the first series of cases back in 1932,[26] wrote=20 decades later "From this small beginning, we have witnessed the = evolution of a=20 Frankenstein monster..."[27]

Johne's Disease

Crohn actually didn't discover Crohn's disease. The first person to = give it a=20 clear description was a Scottish surgeon named Kennedy Dalziel in = 1913.[28] He wrote=20 "I can only regret that the etiology [cause] of the condition remains in = obscurity, but I trust that before long, further consideration will = clear up the=20 difficulty."[29] Eighty-eight years later and the scientific = community is=20 still not sure what causes Crohn's, but Dalziel had a hunch which a = growing=20 number of prominent scientists now think may be correct.

About two decades earlier in 1895, German doctor H. A. Johne was the = first to=20 describe the cause of a disease in cattle characterized by chronic or=20 intermittent profuse intractable diarrhea.[30]=20 Clinically, the disease in cattle was virtually identical to that which = we now=20 know as human Crohn's disease.[31] The gross=20 pathology of the infected cow's intestines likewise had the same = cobblestone=20 appearance and microscopically, the Crohn's diseased intestines and the = diseased=20 cattle intestines were dead ringers.[32] Dalziel=20 wrote that the tissue characteristics were "so similar as to justify a=20 proposition that the diseases may be the same."[33] He=20 theorized that the disease in cattle and the disease in people were the = same=20 entity.

Mycobacterium paratuberculosis

The cattle disease, which became known as Johne's disease (pronounced = yo-neez), is known to be caused by a bacteria called Mycobacterium=20 paratuberculosis, also known as Mycobacterium avium subspecies = paratuberculosis,=20 or MAP.[34]=20 MAP belongs to an infamous class of microbes called mycobacteria which = cause=20 diseases such as tuberculosis and leprosy. In fact, before Johne = properly=20 distinguished MAP from other mycobacteria, the disease in cattle was = thought to=20 be caused by intestinal bovine tuberculosis, hence the name = paratuberculosis or=20 "tuberculosis-like."

Mycobacterium paratuberculosis is one of the most enigmatic bacteria = known.[35] It lives=20 inside the hosts' cells, but has no known toxins and doesn't seem to = damage the=20 cells.[36]=20 The damage, much like in diseases like hepatitis, comes from the hosts' = reaction=20 to it. MAP triggers a massive immune reaction against the body's own = tissues in=20 which MAP is hiding, in this case the gut.[37] It is=20 known that M. paratuberculosis--MAP--causes Johne's disease in cattle, = but does=20 it cause Crohn's disease in people?

Spheroplasts

Paratuberculosis bacteria seem to cause disease in almost every = species of=20 animal so far studied.[38] It's reasonable to assume the same might happen in = humans.=20 ParaTB causes a specific chronic inflammation of the intestines of = cattle,=20 sheep, deer, rabbits, baboons, and three other species of primates.[39] The=20 problem for Dalziel was that he couldn't visualize the bug = microscopically in=20 the surgically resected intestines of patients with Crohn's.[40]

While one can easily pick out MAP in most cases of Johne's disease = with a=20 simple light microscope, to this day attempts to stain and view MAP in = Crohn's=20 disease has been largely unsuccessful.[41] The=20 landmark of most mycobacterial infections is the presence of acid-fast = bacilli,=20 so called because the mycobacterial cell wall soaks up and retains a = particular=20 acid stain.[42] Although failure to see acid fast bacilli in = general is not=20 uncommon,[43] in the intestines of Johne's disease infected = cattle, one=20 can see swarms of acid-fast bacilli; in Crohn's there are none. The = mystery=20 wasn't solved until 1984, when Rodrick Chiodini, a microbiologist at = Brown=20 University's Rhode Island Hospital published a landmark study in which = he=20 actually cultured live paraTB germs from the gut walls of children with = Crohn's=20 disease.[44]=20

It has now been well established that paratuberculosis (and some = other=20 mycobacteria[45]) can shed their cell wall and exist as a what has = been=20 termed a "cell wall deficient" or "spheroplast" form. Since it's the = cell wall=20 that picks up the stain, this form of the bacteria cannot be detected = using the=20 acid-fast stain test.[46] The bug, however, can then reform its cell wall = even years=20 later and revert back to its normal stainable self, which is what = happened in=20 Chiodini's lab.[47] It is thought that this cell-wall deficient form = is=20 responsible for triggering the abnormal immune response which leads to = Crohn's=20 disease.[48]=20

Live Cultures

The next hurdle was the difficulty of consistently culturing the bug = from=20 Crohn's sufferers' intestines.[49] Although=20 MAP has been independently isolated across three continents--cultured = from=20 Crohn's tissue in California, Texas, France, Australia, England, the=20 Netherlands, and the Czech republic[50]--results=20 are still relatively sparse and many labs have reported not being able = to=20 culture it at all.[51] This is not surprising.[52]

In order to isolate a specific bug from the multitude that exist = naturally in=20 the intestine, one has to devise a decontamination technique that kills = other=20 bacteria without harming the target bacterium, in this case MAP. Without = it's=20 protective cell wall, however, cell wall deficient forms are almost = impossible=20 to culture because of the caustic processing techniques required to = isolate=20 them.[53]=20

Even once isolated, MAP is very difficult to grow.[54]=20 Researchers have been trying since 1952 to grow mycobacteria from = surgically=20 removed Crohn's disease tissue.[55] It is=20 thought that Chiodini succeeded where others had failed because of his = many=20 years of experience, combined with access to modern culture techniques = and years=20 of patient work.[56] Some human isolates took up to six years to grow, = even under=20 extremely precise culture and decontamination conditions.[57] Earlier=20 researchers failed to meet these stringent standards for culturing the=20 bacteria.[58]

Even modern labs have been found to be relying on faulty study = design.[59] Moreover,=20 the differences in methods used between labs can be vast.[60] Some labs=20 still use fixed or frozen specimens or use only surface tissues from = superficial=20 biopsies, when it's been shown that one should optimally use fresh[61] resected=20 tissue, as MAP tends to be found deep in the intestinal wall.[62] Some labs=20 working with nonspheroplast forms of MAP from cattle haven't even been = able to=20 grow it. Even under the best circumstances, MAP is a tough bug to = grow.[63]

To this day, many infectious agents have eluded our attempts to be = grown in a=20 lab at all. For example, scientists have never been able to isolate=20 Mycobacterium leprae, the microbe responsible for leprosy. Even = campylobacter,=20 which we now know as the most significant bacteria in food poisoning, = wasn't=20 identified as a human pathogen until the 1970s, when culturing = techniques=20 enabling isolation were finally developed.[64]

Complicating attempts to culture the bug in Crohn's, there seem to be = very=20 few MAP actually involved in the disease process. This has a parallel in = other=20 animals--MAP bacteria in sheep and goat paratuberculosis are often = sparse or=20 even undetectable[65]--and in other mycobacterial human diseases like a = type of=20 leprosy in which just a few mycobacteria are capable of triggering a=20 pathological immune response.[66]

DNA Fingerprinting

Obtaining Crohn's tissue samples is easy--patients are all too = frequently=20 having pieces of their bowel removed--but growing MAP from this tissue = is so=20 difficult that a non-culture based method was needed. This advance came = in the=20 late 1980's when new DNA fingerprinting techniques arrived on the = scene.[67] Using DNA=20 probe technology similar to that used in forensic cases to pick up = minute=20 amounts of DNA, one can determine the definite presence of paraTB = without=20 needing to actually culture and grow it.[68] No longer=20 would researchers have to wait months or years for the spheroplasts to = revert=20 back to normal and start growing again, one could just target, with 100% = certainty, MAP DNA.

Sixty-five percent of bowel samples from Crohn's patients came up = positive,=20 compared to only 4% of those with the similar but different disease = ulcerative=20 colitis.[69]=20 As techniques for extracting and isolating DNA have become better and = better,=20 MAP has been found in intestinal Crohn's tissue with increasingly = positive=20 results.[70]=20 The reason more Crohn's cases were not detected is because the test has = a=20 limited sensitivity, especially when searching for a needle in a = haystack in the=20 gut which is awash in the DNA of billions of other bacteria.[71] DNA probe=20 detection of other low abundance bacterial pathogens, particularly in=20 chronically inflamed tissues--diseases like tuberculosis, Lyme disease,=20 brucellosis and lymphocytic leprosy--have similarly been fraught with=20 difficulty.[72] Isolating chromosomal DNA from mycobacteria in = general is=20 experimentally difficult.[73] There are also other substances in the gut that = have been=20 found to inhibit the test such as bile salts and polysaccharides.[74]

Also accounting for uncertainty in the data[75] is the=20 frequent misdiagnosing of Crohn's disease. For example, it's been shown = that at=20 least 20% of people diagnosed with Crohn's actually have a different = disease,=20 such as ulcerative colitis.[76] There is also considerable debate on whether or = not Crohn's=20 is a single disease entity in the first place.[77] Crohn's=20 may be more of a catchall syndrome describing a number of different = conditions,=20 some of which may not be caused by MAP.[78] Either=20 way, this makes it difficult to interpret data that show that not all of = those=20 we consider to have Crohn's disease test positive for MAP.

As expected, some people without Crohn's--healthy controls--test = positive.=20 Yet just because someone comes in contact with and harbors a specific = germ=20 doesn't necessarily mean that person will come down with the disease.[79] It is=20 estimated, for example, that only 1/3 of calves that ingest MAP ever = develop=20 Johne's.[80]=20 It is also possible, like closely related subspecies, that there are = different=20 strains of MAP, some of which cause disease and some of which don't.[81] The=20 important point is that there has consistently been a highly significant = specific association between Mycobacterium paratuberculosis and Crohn's=20 disease.[82]=20

Association or Causation?

Just because Crohn's sufferers are much more likely to have MAP found = in=20 their gut does not necessarily mean that MAP caused the disease. Another = explanation of the finding could be that this is just an opportunistic = invasion=20 of MAP into diseased tissue, leading to a chicken and egg scenario of = which came=20 first.[83]=20 If MAP just has an affinity for inflamed tissue, however, one would = expect that=20 one would also find MAP more frequently in biopsies of similar diseases = like=20 ulcerative colitis, but this is not the case. Conversely if you look for = the DNA=20 of other nonspecific mycobacteria, one finds that they are uniformly = distributed=20 between Crohn's patients versus controls. This finding is consistent = with the=20 known environmental distribution of mycobacteria, which are present in = 30-50% of=20 all environmental samplings--including water, soil, even air.[84] So other=20 mycobacteria people routinely come in contact with, even the closely = related=20 Mycobacterium avium subspecies silvaticum, are equally distributed among = people=20 whether they have Crohn's disease, or colon cancer, or are completely = healthy as=20 one might expect.[85]

In medicine there is a method used to try to prove that a specific = pathogen=20 causes a specific disease. The first person to definitively prove that a = disease=20 was caused by a particular organism was Robert Koch, who uncovered the = bacterial=20 origin of anthrax in 1876. Koch cultured the bacteria from a diseased = animal,=20 gave anthrax to a healthy animal by inoculating her or him with a pure = culture=20 of the bacilli, and then was able to recover and reculture the bug once = again.[86] These=20 experiments fulfilled criteria proposed 36 years earlier by Henle as = necessary=20 to establish a causal relation between a specific agent and a specific = disease.=20 These criteria are now known as the Koch postulates.[87]

Not only are these experiments arguably unethical,[88] they also=20 can be unreliable in clinical medicine, as other animals may not be = susceptible=20 to the same diseases that we are. For example, the case to prove that H. = pylori=20 caused ulcers was hindered by animal research, as rats and pigs were = tested and=20 seemed to be immune.[89] For this and other reasons, there are some = recognized=20 infectious diseases which have never fulfilled Koch's postulates. = Leprosy, for=20 example, has still never fulfilled more than one of the four criteria, = because=20 it is not possible to culture the culprit bacterium in the laboratory.=20 Nonetheless, Mycobacterium leprae is known to be the cause of leprosy, = and=20 leprosy is known to be an infectious disease.[90] So while=20 not absolutely necessary to fulfill Koch's postulates to prove = causation, they=20 are the most widely accepted method. So researchers set out to the task = and they=20 succeeded--twice.[91]

Chiodini fed chickens pure cultures of the paratuberculosis bacteria = he=20 recovered from the surgically removed intestines of children with = Crohn's=20 disease. The chickens then developed an intestinal disease resembling = Crohn's.[92] In 1986, a=20 different lab fed infant goats a human strain of paratuberculosis and = also found=20 that the bacteria induced a Crohn's-like intestinal disease in the = goats. The=20 same strain was then recovered back from all of them.[93] When asked=20 why there continues to be so much resistance against the idea of MAP as = a cause=20 of Crohn's disease, Chiodini replied "What you have to realize is that = there is=20 a lot of politics in medicine. It's not whether you have the proof of = something,=20 but whether or not the medical community wants to accept it."[94]

Because there have been so many other failed attempts to figure out = the cause=20 of Crohn's, the medical community is very leery of new proposed causes,=20 especially infectious ones.[95] The gastrointestinal community maintains a healthy = skepticism regarding new pathogens as the cause of Crohn's disease, = because=20 different pathogens suspected in the past, such as chlamydia and = measles, have=20 since been disproven.[96] Of all the pathogens once thought associated with = Crohn's in=20 the 80 years it's been researched, MAP is the only one directly cultured = and the=20 only one capable of causing pathologically indistinguishable disease in = other=20 animals.[97]=20

The way that doctors test for the presence or absence of many = infectious=20 diseases is by looking for specific antibodies that our immune system = uses to=20 target the invader. When we test for HIV, for example, we are not = usually=20 testing for the virus directly, we are looking for the presence of = anti-HIV=20 antibodies.[98] If they're found, we can be relatively certain the = person=20 has been exposed to HIV. Similar searches have been launched for = anti-MAP=20 antibodies. Unfortunately scientists have had difficulty finding an = antibody=20 which is specific for MAP.[99] There are some promising new suspects, however, = which are=20 thought to be unique to MAP and have been found in 90% of Crohn's = patients, but=20 in less than ten percent of those with ulcerative colitis.[100] These=20 results not only support the theory, but open new research frontiers. A = vaccine=20 might be developed and the diagnosis of Crohn's may soon be just a blood = test=20 away.[101]=20

Epidemiology

Other potential lines of evidence include population studies. One = would=20 expect that if paratuberculosis was causing Crohn's disease, then the = regions in=20 which there is a high prevalence of Crohn's should overlap with the = regions with=20 a high prevalence of paratuberculosis. While sufficient data is = lacking,[102] a=20 review of the epidemiology of Johne's disease compared with the = epidemiology of=20 Crohn's disease found just that.[103]=20 "Crohn's disease has a very spotty distribution in the world," notes Dr. = Walter=20 Thayer, an expert on the disease at Rhode Island Hospital who worked = with=20 Chiodini to culture MAP from Crohn's patients. "But it's seen only in=20 milk-drinking areas--Australia, southern Africa, Europe, the United = States,=20 Canada, New Zealand. Interestingly, it's not seen in India, where they = do drink=20 milk, but they boil it first."[104]

Critics point to Sweden, which has its share of Crohn's, but whose = cattle are=20 reportedly paratuberculosis free. Unfortunately, the surveillance = testing has=20 been limited.[105] Michael Collins, veterinarian and microbiologist = with the=20 University of Wisconsin, has written "We believe no region in the world = is free=20 of M. paratuberculosis infection in its ruminant livestock. In all = likelihood,=20 Johne's disease is to be found in every country. Being free of the = disease is=20 probably more a function of how hard one has looked than a true lack of=20 incidence."[106] We will see a prime example of this in the = discussion of=20 Ireland.

Another perceived inconsistency in the link between paraTB and = Crohn's is the=20 fact that Crohn's is found more often in urban, rather than rural = populations.[107] Dairy=20 farmers, for example, do not seem to have higher rates of Crohn's.[108] This is=20 not dissimilar from other parallel diseases like bovine TB--tuberculosis = not=20 paratuberculosis--which, centuries ago, was responsible for the deaths = of=20 hundreds of thousands of children who drank unpasteurized milk.[109] The=20 association between tuberculosis contracted by drinking milk and the = rural=20 community was also weak, presumably because of the commercial marketing = and=20 distribution of infected milk.[110]

Any explanation of Crohn's would have to account for the rapid = increase seen=20 in this disease this century.[111] The=20 longest continuous study of the incidence of Crohn's disease is from = Wales,=20 which reports a 4000% increase of the disease since the 1930's.[112] This=20 may be explained by the concurrent rise in paratuberculosis in = intensively=20 farmed dairy herds throughout the century.[113] Thayer=20 asks also "What has happened to dairying in that time? Do you get milk = from your=20 local dairy? No. You get it from big conglomerates that buy from local = dairies=20 and pool all the milk. I think this is possibly the reason the disease = has=20 spread so quickly."[114]

Nick Barnes

Two centuries ago, when milk drinking children were dying en masse = from=20 bovine TB, one of the earliest signs that they had drunken milk from a=20 tuberculous cow was an infection of the lymph nodes that drained the = throat.=20 Scientists think milk is also the source for human exposure to = paratuberculosis,=20 so they wondered if the same thing happened with MAP.

Enter Nick Barnes, a 7 year old boy who developed a painful swollen = lump on=20 the right side of his neck. His family took him to see their doctor, who = decided=20 it needed to be biopsied. The biopsy clearly showed he was infected with = paratuberculosis. This is significant because it was the first = definitive proof=20 that paratuberculosis could infect human beings and cause disease. He = and his=20 family waited. Five years later, Nick Barnes came down with Crohn's = disease.[115] Despite=20 the clear cut case description of a human paratuberculosis infection = followed by=20 the development of Crohn's, the medical community continued to ignore = the=20 growing evidence indicting MAP. There are many precedents of similar = resistance=20 to new ideas in the medical field.

H. pylori

Most ulcers are caused by the immune system attacking the lining of = the=20 stomach. Doctors blamed stress, thinking this led to too much stomach = acid and=20 the excess acid caused irritation which maybe triggered the attack. It = was=20 treated the same way as Crohn's has been treated: symptomatic relief of = the=20 inflammation and surgery. Then two Australian researchers cultured a = tiny=20 bacterium from the lining of the stomach and hypothesized heresy--that = ulcers=20 were actually caused by an infection.[116]

For almost a decade the researchers' ideas were dismissed and = ridiculed.[117] The=20 medical community scoffed at the notion that bacteria could survive in = stomach=20 acid.[118]=20 One of the Australian researchers was so desperate that he actually = drank a vial=20 of the bacteria to prove his point.[119] What=20 finally convinced the medical community, though, was that ulcers = disappeared=20 when patients were treated with the right antibiotics.[120] This=20 discovery revolutionized thinking in medicine. The ulcer-causing = bacteria, H.=20 pylori, is now known as the cause of most ulcers in the world.[121]

Many scientists see a close parallel between the H. pylori story and = paraTB.=20 Just as H. pylori bacteria were the real reason the body was attacking = the=20 stomach lining in ulcers, researchers think that the MAP bacteria are = the reason=20 the body is attacking the intestinal lining in Crohn's. The proposition = that=20 ulcers were an infectious disease was met by nearly universal skepticism = in the=20 medical community.[122] As Dr. Hermon-Taylor, Chairman of the Department = of=20 Surgery at St. George's Medical School in London and leading proponent = of the=20 paraTB-Crohn's link, has noted, "And this [H. pylori] was a bug that you = could=20 see by looking down the microscope, grow in a simple culture system in = the lab,=20 test for immunologically pretty simply, and ordinary tablets readily = available=20 to doctors could make it go away. And it still took eight years for the = penny to=20 drop. Now we've got a bug [MAP] that you can't see, can't grow, hides = under the=20 immunological radar, is a bastard to kill, and the problem it's causing = is far,=20 far greater. If Rod Chiodini and I are wrong, the magnitude of the = problem will=20 only be the economic losses of farm animals, which is costing the US = somewhere=20 between $1.5 and $2 billion a year. If Rod Chiodini and I are right, = then, oh=20 dear, oh dear. We have a big problem. It's going to take a lot to put it = right."[123]

Antibiotics for Crohn's

The lesson researchers learned from stories like H. pylori[124] was=20 that their best bet at convincing the world that MAP causes Crohn's lay = in=20 trying to cure Crohn's--a disease thought incurable--with appropriate=20 antibiotics.[125] Of course there was no guarantee that even if = the disease=20 were caused by MAP that it would respond to treatment.[126] For=20 example, we can cure most pulmonary TB with antibiotics, but when TB = bacteria=20 move from the lung to the intestine and cause intestinal TB, it cannot = typically=20 be cured by antibiotics alone.[127]=20 Researchers, though, set out to try.

Before we knew that ulcers were treatable with simple antibiotics, = people=20 underwent repeated grueling surgeries--some almost as risky and = debilitating as=20 Crohn's sufferers now undergo. Not only would a cure save Crohn's = sufferers from=20 the surgeon's knife, but it would also protect them from the toxic = chemotherapy=20 regimens currently used just for symptom relief, which can include=20 immunosuppressants like steroids, cancer chemo agents[128] and=20 even thalidomide.[129]

Researchers started trying antibiotics they thought might kill MAP in = Crohn's. Early results were disappointing,[130] leading=20 to much of the deep-seated resistance among clinicians to accepting MAP = as the=20 cause of Crohn's.[131] Yet in hindsight, it turns out tht doctors were = using the=20 wrong antibiotics, in the wrong combinations, for an inadequate period = of time.=20

Perhaps because of the name similarity, many researchers assumed that = antibiotics effective against M. tuberculosis should also be effective = against=20 M. paratuberculosis.[132] They were wrong; when one actually tested = antibiotics=20 against MAP in a lab, researchers found that it was in general resistant = to=20 anti-tuberculous drugs.[133] They didn't work in cows[134]; they=20 don't work in people.[135]

Another problem with some early studies was that they used=20 monotherapy--meaning that they only used a single agent--which is = rarely, if=20 ever, effective in mycobacterial diseases because mycobacteria are so = adept at=20 developing resistance.[136] By giving multiple antibiotics at once, one = decreases the=20 chance that resistance will develop.

Adequate treatment duration had also been neglected. Mycobacterial = infections=20 in general are difficult to eradicate; prolonged treatment is required = and=20 relapses, either on treatment or off treatment, are common.[137]=20 Tuberculosis takes months to treat; leprosy takes years--sometimes a=20 lifetime--to treat. Our best estimate of how long it might take to rid = the body=20 of MAP can be made by studying pathogens in the same species. Infections = caused=20 by one of MAP's closest cousins routinely require treatment for 3-4 = years with 3=20 or 4 different antibiotics.[138] In some cases, it took five antibiotics all used = in=20 combination for 5 years before clinical improvement was achieved. We = cannot=20 expect trials using too few drugs, the wrong drugs, or even the right = drugs for=20 too short a time, to be successful.[139]

There are some factors which complicate any trial, even if the agents = are=20 chosen and used appropriately. Crohn's can be a cyclical disease, with = periods=20 of flare-ups and remissions, so approximately 20% of Crohn's patients = during a=20 treatment period will spontaneously improve on their own. The placebo = effect is=20 also expected to play a role in 30-40% of patients undergoing short-term = therapy. And as mentioned previously, Crohn's is a poorly delineated=20 disease--20% of people diagnosed with Crohn's may actually have = something=20 else.[140]=20 There is also clinical, epidemiological, and molecular evidence = indicating that=20 there are two distinct clinical manifestations of Crohn's disease, which = each=20 may respond differently to treatment. These factors make it difficult to = evaluate any therapeutic intervention.[141]

Despite these hurdles, the latest results are quite promising,[142] Instead=20 of just blindly trying different antibiotics, scientists actually = endured the=20 laborious task of testing the antibiotics one by one on MAP in the lab. = The=20 breakthrough came in 1992 when the newly developed antibiotic = clarithromycin was=20 found to be the most effective known killer of Mycobacterium = paratuberculosis.=20 Many of the antibiotics used earlier worked by blocking cell wall = synthesis. But=20 Crohn's is thought to be caused by the spheroplast form of MAP which = doesn't=20 have a cell wall; it's therefore no wonder these earlier drugs didn't = work.=20 Clarithromycin, and an antibiotic called rifabutin, have a different = mechanism=20 of action, blocking protein synthesis.[143]

Another reason why drugs like clarithromycin (called macrolides) work = against=20 paraTB where others have failed is that MAP is an intracellular = pathogen. They=20 live inside our cells (another reason why they're so hard to see under a = microscope). Only certain antibiotics, like macrolides, can penetrate = inside=20 human cells and still work effectively.[144] None of=20 the previous MAP trials properly evaluated these newer macrolide = antibiotics.[145] The=20 time was ripe for a trial of these newer agents in Crohn's disease.

An Attempt at Cure

The first trial took place in London, published 1997.[146]=20 Researchers chose to use rifabutin and clarithromycin because they seem = to=20 complement or synergize with each other.[147] The=20 treatment was named RMAT, Rifabutin and Macrolide Antibiotic Therapy. =

Fifty-two patients with Crohn's disease, most of whom had persistent = severe=20 symptoms resistant to conventional treatment, were studied. Six patients = had to=20 be excluded, due mostly to intolerance to the antibiotics,[148] though=20 in general the RMAT medications tend to have a much higher tolerance = rate and=20 far fewer side effects than the current immunosuppressive drugs used for = Crohn's.[149] The remaining 46 patients were treated with RMAT = for about=20 a year. Of the 46 patients who were able to tolerate RMAT, 43 went into = clinical=20 remission, for a remission rate of 94%.[150]

A two-year follow-up was performed. The majority of patients in whom = a=20 clinical remission was initially induced remained symptom free off of = all their=20 previous medications.[151] Similar trials in other centers have reproduced = these=20 findings.[152],[153],[154],[155],[156] The fact that some patients relapsed after = treatment was=20 stopped may point to the difficulty in eradicating the organism or = perhaps that=20 they had been re-infected.[157] Hermon-Taylor, one of the principal = investigators of the=20 original trial, is currently recommending patients take RMAT regimen for = at=20 least 2 years. Among patients who respond to treatment, remission occurs = slowly=20 over the first three to six months of treatment. Symptoms often get = worse before=20 they get better, as in the drug treatment of other chronic mycobacterial = diseases such as leprosy.[158]

Based on this pilot study, RMAT has the highest reported remission = rate of=20 any known treatment for Crohn's disease and the lowest reported relapse = rate,=20 including all current immunosuppressive treatments.[159] Thought=20 to be an incurable disease, doctors seem to have been able to induce = profound=20 long-term remissions in the majority of patients with Crohn's disease.[160] Not=20 only do patients stop having symptoms, but their intestines actually = show=20 evidence of healing, an unprecedented achievement.[161] "If=20 this were cancer," said one RMAT researcher, "we would be calling these = long=20 remissions a cure."[162] Hermon-Taylor told the press "I've seen people = who were=20 without hope get better like magic. I've been a doctor for nearly 40 = years, and=20 it's the best thing I've ever seen in clinical medicine."[163]

Though the preliminary results of this and other pilot studies are=20 encouraging, Hermon-Taylor is the first to point out the limitations of = the=20 study--it was too small and there were no controls.[164] "We=20 were actually denied the funding to do a randomized control trial," he = said. "So=20 I did the best that I could with what I've got."[165] To=20 date, according to the Cleveland Free Times article that won = 1999's=20 Project Censored Award, twenty-five of Hermon-Taylor's grant proposals = submitted=20 both here and abroad were rejected.[166]

Chiodini estimates he's similarly submitted over two dozen grant = proposals to=20 the National Institutes of Health, the USDA and the Crohn's and Colitis=20 Foundation of America, but to no avail.[167] Drugs=20 trials run in the United States have traditionally been supported by the = pharmaceutical industry, but just as H. pylori threatened to deprive = some of the=20 largest corporations in the world of billions of dollars (anti-ulcer = medications=20 were the world's best-selling prescription drugs), the drug industry = scores huge=20 profits from increasingly complex and expensive maintenance Crohn's = treatments,=20 which must be administered for the rest of the patient's life.[168]=20 Needless to say, financial support from the corporate sector has not = been=20 forthcoming.[169]

Nevertheless, these preliminary results must be reproduced to be = seriously=20 considered. Larger scale controlled studies are currently in progress to = obtain=20 better data.[170] The most promising is a phase III clinical trial = of RMAT=20 in Australia which has been designed as a double-blind, multi-center, = controlled=20 clinical trial involving over 200 patients with Crohn's in at least = seven major=20 cities across the continent.[171]=20 Unfortunately, they seem to be having a problem securing patients for = the=20 study.[172] A controlled RMAT trial has also reportedly been = initiated=20 by the National Institutes of Health.[173]

Milk and Pus

Professor Hermon-Taylor, internationally known expert on Crohn's and = MAP=20 genetics, who has researched the illness for 20 years, said: "If there = were no=20 MAP I believe there would be almost no Crohn's disease. It is certainly=20 responsible for between 60 per cent and 90 per cent of all cases and I = would=20 think that it is more likely to be 90 per cent."[174]=20 Obviously, everyone who's exposed to paraTB doesn't come down with = Crohn's=20 disease, as is the case in virtually all infectious diseases. As = mentioned=20 previously, just because one comes in contact with a pathogen does not=20 necessarily mean one comes down with the illness. Genetic and = environmental=20 factors facilitate establishment, persistence, and production of = disease.[175]

H. pylori, for example, (the bacterium proven to cause ulcers) is one = of the=20 most common of all bacterial infections[176]--a=20 third of Americans have H. pylori in their stomachs.[177] A third=20 of us, however, don't have ulcers;[178] some=20 people are just susceptible. Similarly, only about one in three hundred = people=20 exposed to tuberculosis actually come down with active disease.[179] Until=20 we know why some and not others fall ill, all one can do is to try to = minimize=20 exposure to the pathogen. For example, people should not let those with=20 tuberculosis cough in their face.

Drinking milk from cows infected with Johne's disease is how people = are=20 exposed to paratuberculosis. Based on DNA fingerprinting techniques, = there are=20 two strains of MAP: one that affects cattle, and one that affects goats = and=20 sheep. All human isolates so far have been of bovine origin,[180]=20 implicating milk.[181] Milk is the "logical" focus of exposure[182] because=20 cows with Johne's disease secrete paraTB abundantly in their milk.[183] Even=20 sub-clinical cows--those that are infected but appear perfectly = normal--shed=20 paraTB bacteria into their milk.[184]=20 Although these bacteria are found free-floating in milk, their = transmission may=20 be facilitated by their presence inside pus cells.[185] This is=20 a particular problem in the United States, as we have the highest = permitted=20 upper limit of milk pus cell concentration in the world--almost twice = the=20 international standard of allowable pus cells.[186] By US=20 federal law, Grade A milk is allowed to have over a drop of pus per = glass of=20 milk.[187]=20 These pus cells may facilitate the transmission of paraTB.[188]

Pasteurization

In England, researchers took milk off grocery shelves and tested it = for the=20 presence of paratuberculosis bacteria using DNA probes. Depending on the = time of=20 the year, up to 25% of milk cartons contained paratuberculosis DNA.[189]=20 Interestingly, the seasonal variation coincided with the periods when = Crohn's=20 patients tend to suffer relapses.[190] The=20 researchers tried to culture live paraTB bugs from the milk, but were = largely=20 unsuccessful, because cow's milk is such a stew of microbes that fungal=20 overgrowth and faster multiplying bacteria took over the samples.[191] The=20 question then remained, did the positive DNA samples in up to a quarter = of the=20 milk supply indicate live or dead paratuberculosis bacteria? Can paraTB = survive=20 pasteurization?

Historically, pasteurization had been established in order to kill = paraTB's=20 cousin, bovine tuberculosis.[192] TB was=20 thought to be one of the most heat resistant human pathogens, so the = temperature=20 was set at approximately 62o Celsius (144o Fahrenheit) for a half an = hour.[193] Later,=20 the disease Q fever was discovered, so the temperature was increased to = 63o=20 Celsius.[194] Now the HTST method, which stands for High = Temperature,=20 Short Time, is predominantly used--72o Celsius (162o F), but only for 15 = seconds.[195] While 72o C kills most bacteria, = paratuberculosis has been=20 shown to survive 15 seconds at 90o Celsius (194o F).[196] By=20 hiding in milk in fat droplets, pus cells, and fecal clumps,[197] paraTB=20 might be able to survive at even higher temperatures.[198] Second=20 only to prions[199] (which cause mad cow disease), paratuberculosis = is=20 considered the most heat resistant pathogen in the human food supply.[200]

Johne's on the Rise

According to the Food and Agriculture Organization of the United = Nations,=20 Johne's disease is one of the most serious diseases affecting the cattle = industry.[201] Although it is found in cattle populations = throughout the=20 world, the United States appears to have the worst paratuberculosis = problem on=20 the planet.[202] In 1997, the USDA released a long-awaited report = of the=20 national prevalence of Johne's disease. Surveying over 2500 dairy = producers,[203] they=20 showed that between 20-40% of US dairy herds were infected, a figure = that they=20 concede is probably an underestimate.[204] Since=20 milk from an entire herd is likely to be pooled together in tankers for=20 transport to processing plants, the 20 to 40% figure is likely to = indicate the=20 level of contamination in American milk.[205]

Just as Crohn's disease is increasing in the human population--it may = be no=20 coincidence that the US also has the world's highest incidence of = Crohn's ever=20 recorded[206]--Johne's disease is spreading among dairy = cattle.[207] Johne's=20 disease is spread primarily by the fecal-oral route. One can imagine how = a cow=20 with intractable diarrhea can thoroughly contaminate her surroundings[208] and=20 just a few bits of swallowed manure can potentially infect a calf.[209] Overtly=20 infected animals, losing up to 300 lb. of body weight in one week[210] can=20 shed as many as ten hundred trillion bugs a day.[211] One can=20 also imagine what intensive modern farming practices have done for the=20 disease.[212] Grazing bigger and bigger numbers of cattle on = smaller and=20 smaller plots of land is one of the reasons this dreaded disease is such = a=20 growing threat.[213] And every time animals are transported between = farms, new=20 herds may be infected. If no changes are made, the dairy herd infection = rate is=20 expected to reach 100%.[214]

USDA Farce?

With the growing Johne's epidemic, US governmental regulatory = agencies have=20 been in a bind. The only thing allegedly standing between people and the = paratuberculosis bacterium are 15 seconds at 72o Celsius.[215] The=20 government has had to somehow convince the families of Crohn's patients = who=20 started to ask questions that pasteurization was foolproof. The problem = was that=20 the preponderance of the scientific evidence was against them--almost = every=20 study ever done simulating pasteurization conditions showed that paraTB = survived=20 the 15 seconds at 72o C.[216] So USDA scientists designed their own = experiment.

Critics accuse the USDA of trying to ensure that no paraTB would = survive in=20 their pasteurization experiment by first crippling the bacteria. Very=20 irregularly, with no precedent in the scientific literature for using = this type=20 of approach,[217] the USDA began their experiment by first = "starving" the=20 MAP bacteria,[218] exposing them to high-frequency sound waves, and = freezing=20 them--a technique that has been shown conclusively to weaken MAP.[219] They=20 were also criticized for making a number of methodological mistakes and=20 omissions.[220],[221] Then, allegedly to make absolutely sure not a = single bug=20 would grow, they used an inadequate culture media[222] and=20 report culturing them for only 2 to 3 months.[223] It is=20 widely accepted that the minimum time it takes to ensure the growth of = paraTB is=20 4 months.[224]

It is perhaps not surprising that no MAP grew from the pasteurized = milk in=20 their experiment. The researchers concluded: "Results indicate that the=20 transmission of live paraTB bacteria via pasteurized milk is unlikely." = Despite=20 fifteen[225] years of better research to the contrary,[226] based=20 on that single questionable study, in a letter dated Feb. 9, 1998, = Joseph=20 Smucker, the leader of the FDA's Milk Safety Team wrote "After a review = of the=20 available literature on this subject, it is the position of FDA that the = latest=20 research shows conclusively that commercial pasteurization does indeed = eliminate=20 this hazard."[227]

The FDA has argued that earlier pasteurization studies used = unrealistically=20 high levels of MAP that wouldn't be expected to exist naturally in the = raw milk=20 supply.[228] This is not a tenable criticism, primarily = because the=20 studies in question followed the published guidelines on the proper = challenge=20 concentration in the design of thermal inactivation studies.[229] Also,=20 the concentration of MAP in raw milk is unknown. Cattle infected with = Johne's=20 disease have uncontrollable diarrhea, which "sprays" out from them in = liquid=20 form. Due to the close proximity of the cow's anus to her udders, it is=20 unavoidable that an infected cow's udders will be smeared with feces,=20 potentially leading to the contamination of her milk with high numbers = of=20 Mycobacterium paratuberculosis.[230] The=20 feces contaminating her milk can have as many as a trillion paraTB bugs = per=20 gram.[231]=20

Off the Shelf

Despite its shortcomings, the USDA study continues to be cited and = the rest=20 of the scientific literature ignored by the government and the = agricultural=20 press.[232] Hoard's Dairyman, for example, cited the USDA = study and=20 concluded that "pasteurization destroys this dangerous disease."[233] It=20 wasn't until the year after the study was published that such assertions = were=20 proven to be wrong.

The only way to demonstrate for sure that live paraTB bacteria = survive=20 pasteurization is to culture a colony of living paratuberculosis = bacteria from=20 retail pasteurized milk off the grocery shelf. In 1998, that is just = what=20 researchers did. Choosing Ireland, which has the highest per capita milk = consumption in the European Union,[234]=20 investigators went to 16 retail outlets and got 31 cartons of milk which = were=20 pasteurized at commercial dairies large and small.[235] Six=20 grew out live paraTB, 19%--almost 1 in 5.[236] This=20 caused a national food scare with daily front page headlines, not a word = of=20 which crossed the Atlantic.

In an editorial entitled "Media and Censorship," the Editor-in-Chief = of the=20 Cleveland Free Times wrote "The dairy lobby is notoriously powerful = inside the=20 Washington D.C. beltway. And a tax on dairy farmers helps the dairy = industry=20 spread its advertising dollars around generously (most notably the 'Got = Milk?'=20 ad campaign), to the point where the wholesomeness of milk goes = virtually=20 unquestioned in the media. How else can it be explained that the = possible link=20 between a bacterium in milk and Crohn's disease is virtually unknown in = the=20 United States, despite front-page coverage in England and other places = around=20 the world."[425]

When the results of the Irish study were released, crisis management=20 specialists called the ramifications "enormous," "horrific." Dairy = industry=20 experts described it as a "significant blow to the industry," = "accelerating the=20 long-term decline of milk," and noting "It's not a market that can just = bounce=20 back."[237] Dairy industry leaders reacted angrily to the = suggestion=20 that pasteurization was inadequate. The British National Dairy Council's = "Information Officer," said she wished the investigators had contacted = the=20 industry before publishing their scientific findings.[238]

Responding to public pressures, the British government initiated a = nationwide=20 thousand-sample survey of retail pasteurized milk. The announcement = splashed=20 headlines all over Europe, but there was still no word in the American = press.[239] The=20 preliminary findings of the British government's survey were released in = April,=20 2000. Three percent NAME=3D"fnB240" HREF=3D"#fn240">[240]--3 = out of every=20 one hundred cartons of milk off the shelves--grew out live = paratuberculosis=20 bacteria,[241][242] Based on the detection threshold of = these tests,=20 each quart had to contain at least about a million paraTB germs to come = up=20 positive.[243]

A year and a half earlier, after the announcement that milk was = contaminated=20 by at least paraTB DNA, the three British supermarket giants--Tesco, = Sainsbury=20 and Safeway--announced that milk pasteurization time would be increased = from 15=20 seconds to 25 seconds, to reassure the public that their products were = safe.[244] The=20 finding of live paratuberculosis bacteria in retail milk over a year = later has=20 fueled the skepticism that the 10 second change would make any = difference.[245] The=20 change was not based on science--in fact there is a suggestion that some = paraTB=20 can survive pasteurization temperatures for 9 minutes[246] or=20 longer.[247]

Public Relations

Despite the release of these findings, the British Agriculture = Minister said=20 on national television: "I drink pasteurized milk and it is safe to do = so...=20 with confidence," a claim reminiscent of a previous Minister's = assurances about=20 beef from cattle infected with mad cow disease.[248]=20 According to the Royal Statistical Society, contaminated beef still has = the=20 potential of killing 13 million people who consumed it and are currently = incubating the disease which Britain's Health Secretary called the worst = form of=20 death imaginable.[249]

The same assurances are echoed in the US. For example, the director = of the=20 USDA National Animal Disease Center, feeling assured that pasteurization = eliminated any health threat said, "I don't hesitate to feed [milk] to = my 8-year=20 old."[250]=20 The FDA chooses to continue to base national safety policy on the single = flawed=20 USDA study,[251] even now that it's been superseded by proof that = its=20 conclusions are wrong (the US mandates the same pasteurization method = that is=20 used in Britain and Ireland).[252]

The FDA's continued insistence that pasteurization eliminates the = risk of=20 contracting paraTB--despite clear evidence to the contrary--puzzled Kurt = Gutknecht, the editor of the highly respected industry publication = Wisconsin=20 Agriculturist. He called up Joe Smucker, the leader of the FDA's = Milk Safety=20 Team, and asked him about the FDA's official "commercial pasteurization = does=20 indeed eliminate this hazard" statement. Smucker replied that he did not = have=20 "clearance from the FDA" to speak to him on the subject. Surprised at = Smucker's=20 reluctance to talk to him, the editor went to the official FDA = spokesperson, who=20 described the refusal of an FDA official to not respond directly to = press=20 inquiries as "very unusual." Gutknecht turned his attention back to the = Milk=20 Safety Team which no longer returned his phone calls.[253]

The industry and/or[254] government knows, however, what kind of time = bomb they're=20 sitting on.[255] According to one industry expert, the = incrimination of MAP=20 in human disease would cause enormous economic damage to animal = agriculture=20 industries. An article in Milk Science International entitled = "Mycobacterium=20 paratuberculosis: A possible agent in Crohn's Disease?" warns that "the = present=20 state of knowledge is... potentially catastrophic for the dairy industry = should=20 existing information be used in a sensationalist manner."[256]

Hidden Threat

Johne's disease is one of the most difficult diseases to recognize = and=20 control.[257] This is in part because of MAP's ability to = resist=20 destruction in the natural environment. It has reservoirs in pasture = and,=20 perhaps, in other animal populations. Paratuberculosis has spread, for = example,=20 from dairy cattle to wild free-ranging white tailed deer in the state of = Connecticut.[258] The chief reason that paraTB is so hard to = prevent and=20 control, however, is its notoriously covert nature.

Paratuberculosis has been called a "spectral disease,"[259] a=20 "hidden threat,"[260] an "insidious problem for the nation's dairy = herds."[261]=20 Although infections are usually initiated during calfhood, clinical = disease does=20 not appear until adulthood.[262] During this incubation period, which can last = between 6=20 months[263] and 15 years,[264] the=20 infection is invisible.[265] Sub-clinically infected animals don't have = diarrhea or=20 other typical visible signs of Johne's, but they are carriers and can = shed the=20 bacteria into the environment, giving paraTB ample opportunity to become = entrenched in a herd before it is apparent that a problem even exists.[266]

In this way, the Johne's disease problem has been likened to the tip = of an=20 iceberg--the so-called "iceberg effect."[267] By the=20 time a single clinical case surfaces, five[268] to=20 fifteen[269] or twenty[270] others=20 may be infected in the herd. If the clinically affected animal had been = born on=20 the farm, a minimum of 25 other animals are probably infected--perhaps = as many=20 as 50--and less than 30% of those would be detectable by currently = available=20 tests.[271]

Johne's may also be clinically hard to detect. While in some = instances the=20 disease progresses relatively rapidly, with the interval between the = appearance=20 of wasting and death measured in months, in other cases, after the = initial loss=20 of condition, there may be no clinical deterioration for long periods of = time.=20 Since the first signs of clinical disease are progressive weight loss = and a drop=20 in milk production, farmers may just cull the animal without requesting = further=20 diagnosis.[272] Also, like Crohn's, Johne's can go into periods = of=20 remission which can last for weeks or even months.[273]=20 Finally, Johne's can mimic other diseases like intestinal parasitism,=20 malnutrition, salmonellosis, winter dysentery, etc.[274]

Traditional control methods have involved culling infected animals = and using=20 hygiene methods to prevent new infections.[275]=20 Removing infected animals alone has proven ineffective because of the = latency=20 period and because the bacterium survive so well outside the body. As = one=20 commentator noted, "An iceberg is not destroyed by the removal of the = tip!"[276] Another=20 proposal has been to kill off the entire herd, an option termed "herd = disposal."=20 The plan would then be to disinfect the barns and wait a year or so = before new=20 animals are allowed to pasture. This measure will likely never be = initiated,=20 though, because paraTB is so widespread that the resulting financial = burden=20 would be considered too great.[277]

After culling, the next most effective action is considered to be = segregation=20 of the infected animals.[278] Strict hygiene, down to the washing of boots, is = necessary=20 to prevent cross contamination--only a few grams of manure are needed to = infect=20 a calf.[279] Surveys show that many of these basic steps are = not=20 followed, however. For example, in approximately a third of operations, = the=20 cows' udders are not routinely washed prior to collecting colostrum or = before=20 nursing.[280]

While some calves are infected in utero,[281]=20 removing newborn calves from the mother immediately upon birth is = considered an=20 effective control measure because it eliminates the newborn's attempt to = nurse=20 and risk ingesting infectious manure.[282]=20 Currently, about two thirds of dairy operations report taking the calf = away from=20 the mother within 24 hours.[283] There are fears among the animal welfare = community that=20 Johne's disease management will intensify this irresponsible[284]=20 practice.

Disposal of infectious feces creates a quite a problem. Some industry = specialists have advocated special landfills, while others have made the = potentially hazardous proposal to "as a last resort, spread [it] on = permanent=20 crop land."[285]

Conspiracy of Silence

Despite its pervasiveness and its ability to severely impact milk = production=20 and destroy whole herds of cattle, Johne's disease remains an industry = problem=20 that is not openly discussed.[286] In an=20 article entitled "Johne's Disease: a Dairy Industry Perspective," = Johne's is=20 described as "Something that farmers talk about secretly--whisper behind = hands."=20 One dairy scientist stated that in all his years he had never heard an = open,=20 frank discussion of Johne's disease and calls for end of the "whispering = campaign."[287] Dairy farmers try to hide the fact that they = have the=20 disease in their dairy herds.[288] As an=20 article in Cornell Veterinarian notes, "Farmers prefer not to = acknowledge=20 its presence and enshroud suspect cases with secrecy."[289] It is a=20 problem that is kept out of sight and out of mind. As one dairy farmer = put it=20 "It's [Johne's] a dirty word. It's like AIDS--you don't talk about = it."[290]

This conspiracy of silence extends beyond the producers to encompass = the=20 entire industry to the point of interfering with scientific dialogue.[291] From=20 the Journal of Dairy Science: "Fear of consumer reaction... can = impede=20 rational open discussion of scientific studies."[292] Without=20 doubt, says Chiodini "the dairy and regulatory industries are concerned=20 vocally... but their concern is limited to the possibility of 'bad = press' to the=20 industry rather than a concern for the truth or public health."[293]

The secrecy has successfully bred ignorance. Over a century after the = disease=20 was identified, almost half of all dairy farmers nationally surveyed by = the USDA=20 didn't know anything about the disease.[294] And=20 those with the largest herds--the herds most likely to be infected[295]--were=20 found least likely to have known of the disease.[296] Karen=20 Meyer, then Executive Director of the nonprofit Paratuberculosis = Awareness and=20 Research Association (PARA), placed the blame on the representatives of = the=20 dairy industry. At a meeting of the USDA's United States Animal Health=20 Association (USAHA), she challenged dairy producers to become more = proactive.=20 "If there are organizations you have been relying on for your = information and to=20 protect your interests, they have failed you miserably."[297] "I=20 think we underestimate farmers," she told the Wisconsin = Agriculturist.=20 "If they even thought they were making someone sick, it would break = their=20 hearts."[298]

US Inaction

The USDA has been accused of continuing to keep its head in the sand. = Industry specialists blame the federal government for "grossly = underfunding"=20 research, with less than one percent of its animal disease grant budget=20 allocated to Johne's.[299] As Alan Kennedy, a co-founder of PARA and = himself a=20 sufferer of Crohn's disease remarked, "yet another case of = CJD--Conflicting Job=20 Description." The USDA is mandated to regulate animal industries and = food=20 safety, but it is also responsible for promoting these same agricultural = products.[300]

The first US case of Johne's was discovered in Pennsylvania in = 1908.[301] Almost=20 a century later there is still no mandated control program,[302] even=20 though as far back as 1922 scientists published warnings of the danger = posed by=20 the disease and outlined effective methods of controlling and = eradicating it.=20 Efforts to control and eradicate Johne's disease have been grossly = inadequate.[303] "In the=20 75 years following the release of that publication, there's very little = that any=20 state has done to try to control the disease," says Collins, the = University of=20 Wisconsin veterinary researcher. Meanwhile, as predicted in 1922, the = disease=20 has continued to spread silently and surely. According to the USDA's = figures,=20 there are now three quarters of a million cattle infected with paraTB in = the=20 United States.[304]

The reason that Johne's has spread to such a degree is because there = have=20 been no direct constraints on the transport of infected animals.[305] Almost=20 without exception, paratuberculosis is introduced into a herd through = the=20 addition of an asymptomatic infected carrier animal. Almost every = infected herd=20 can trace the infection to the purchase of an infected cow[306] that=20 appeared healthy when offered for sale.[307]=20 Disturbingly, the USDA found that dairy farmers with infected herds were = no less=20 likely to sell replacement cows to other farms than owners of = noninfected=20 herds.[308]

Regulatory vets know and accept this fact, acknowledging that = movement=20 restrictions on infected animals must exist for an effective control = program.=20 However, as described in the Veterinary Clinics of North America = , "if=20 the voluntary program imposes movement restrictions, it could quickly = become a=20 regulatory program and not have widespread support and participation = from the=20 livestock industry."[309] In fact the Code of Federal Regulations (part = 80) was=20 recently changed to remove restrictions on the interstate movement of = Johne's=20 disease positive animals.[310] The change was made because of pressure from the = livestock=20 industry.[311]

Though not putting its money where its mouth is, the USDA insists = that the=20 agency is doing everything it can with regard to Johne's disease.[312] The=20 USDA, for example, cites the formation of the National Johne's Working = Group in=20 1994. However, the executive committee of the group is composed of three = people:=20 one is John Adams of the National Milk Producers Federation and another = is Gary=20 Weber a director of the National Cattleman's Beef Association.[313]

For those that remember the Oprah Winfrey mad cow fiasco, Weber was = the=20 cattleman defending cow cannibalism. "Now keep in mind," he said on that = show,=20 "before you--you view the ruminant animal, the cow, as simply a=20 vegetarian---remember that they drink milk." Years earlier he told = industry=20 publication Food Chemical News that the cattle industry could indeed = find=20 economically feasible alternatives to feeding rendered animal protein to = animals=20 raised for slaughter, but that the Cattlemen's Association did not want = to "set=20 a precedent of being ruled by activists."[314]

Not surprisingly the National Johne's Working Group has officially = come out=20 against making Johne's a reportable disease, advocating that all = attempts at=20 control be voluntary.[315] In a moment of rare candor, one Working Group = member=20 explained why: "If the farmers have to report positive cows, then it = will be=20 like the sheep scrapie [mad sheep disease] program. Instead of reporting = the=20 disease, the farmers will 'shoot, shovel and shut up.'"[316]

A year earlier, a national paratuberculosis certification program had = been=20 started in order to identify low risk herds, but only 1% of dairy = operations=20 reported participating in the program, citing associated costs.[317] Less=20 than 15% of the dairy producers appear to test for Johne's.[318] In 1997=20 the Johne's Working Group set up a similar program designed to be more=20 affordable,[319] but again chose to keep it strictly optional, = relying on=20 the "livestock industry in each state to sell its economic advantage to = its=20 members."[320] As a concession to the industry, there is still = no=20 federally mandated Johne's Disease control program.[321] Some=20 states have Johne's control programs, but without exception they are=20 noncompulsory.[322] Just as government deregulation of industry may = have led=20 to the mad cow disaster in Europe, the lack of industry accountability = may also=20 play a pivotal role in the human consequences of the paratuberculosis=20 epidemic.[323]

The United States is being left behind in the world-wide race to = eliminate=20 paraTB.[324] The Netherlands, one of Europe's largest dairy = exporters,=20 has pledged to eradicate paratuberculosis by the end of this year by = instigating=20 a compulsory eradication program.[325] "To=20 minimize the risk of human exposure to paratuberculosis" is one of the = explicit=20 reasons given for the Dutch program.[326] Sweden=20 seems to be closest to winning the battle, probably because it was the = first=20 country whose control efforts were non-voluntary.[327]=20 Australia is currently also certifying herds with a view to = eradication.[328]=20 Although there are currently no restrictions on international trade as a = result=20 of the disease,[329] that may well change and potentially threaten = America's=20 $700 million dairy product export industry.[330]

Mike Collins began his messages to both the Johne's Disease Committee = and the=20 general session of the US Animal Health Association with the same words = "Don't=20 shoot the messenger."[331] Rather than participating in serious dialogue = around the=20 issue, the dairy industry has been accused of spending its energies = slinging mud=20 at researchers in the field,[332] giving=20 lip service and vainly hoping it just all blows away.[333]=20 Christine Rossiter, senior extension veterinarian with the Cornell = University=20 Veterinary Diagnostic Laboratory, told the Wisconsin = Agriculturist that=20 those who decide to address the issue are put at risk and there's "no = value=20 placed by the industry on a person who wants to do something about = Johne's.=20 Nobody wants to take it on."[334]

At an international colloquium on paratuberculosis, Chiodini = expressed his=20 view that the current focus of the American dairy industry "could put = the=20 industry in the same light as the tobacco industry, being accused of a = cover-up=20 and faced with all sorts of liabilities."[335] Paul=20 Strandberg, Assistant Attorney General of the State of Minnesota warned = the=20 Johne's Committee that if they chose to be less than forthright about = the=20 possible link between milk and beef and Crohn's Disease, they could wind = up on=20 "60 Minutes" in the middle of a media circus.[336]

Off the Shelf USA

In order to put the problem in perspective and get the issue out in = the open,=20 the consumer movement needs to get a study of retail milk supplies in = the US=20 funded. That is the recommendation of the Paratuberculosis Awareness and = Research Association.[337] That is the recommendation of researchers in the = field.[338] Not=20 only has industry allegedly "totally ignored" this approach,[339] one=20 observer wrote that it would be "political suicide" for a researcher in = the US=20 to even suggest such a thing.[340]=20 However, there have been two brave souls. Year after year, Chiodini and=20 Hermon-Taylor, world recognized authorities on MAP on Crohn's, have = submitted=20 proposals to the USDA and to the FDA to test retail milk supplies, and = year=20 after year their proposals have been rejected.[341]

At a meeting of the US Animal Health Association, a resolution was = debated on=20 whether or not to recommend that the USDA test retail dairy products in = the=20 United States for the presence of live paraTB bacteria. John Adams, the = National=20 Milk Producers Federation executive member of the Johne's Disease = Working Group,=20 was quite vocal in his opposition: "The FDA has already stated their = position.=20 They are confident that pasteurized milk is safe. We don't need to test = retail=20 milk."[342]

Steve Merkel, a founding member of the Paratuberculosis Awareness and = Research Association and whose wife has suffered with Crohn's disease = since=20 1960,[343]=20 replied "With all due respect, sir, if milk is as safe as you say it is, = then=20 retail testing will simply confirm that fact. Are you afraid of retail = milk=20 testing because you are afraid of what you might find?" The resolution = was voted=20 down by an overwhelming majority.[344]

The Paratuberculosis Awareness and Research Association kept at it. = Finally,=20 in 1999, PARA successfully submitted two resolutions to the Johne's = Disease=20 Committee, one recommending the testing of retail milk and milk products = for the=20 presence of live MAP and another recommending research to determine what = cooking=20 temperatures are needed to reliably kill MAP in ground beef. Although = both=20 resolutions passed unanimously in open committee, they were later voted = down=20 behind closed doors. PARA saw this as the USAHA going on record as = deliberately=20 choosing ignorance about the presence of MAP in food products for human=20 consumption.[345]

The United States Animal Health Association tried to justify why the=20 resolutions were quashed: "During the discussions of these resolutions, = there=20 was much concern about the feasibility of end-product testing of milk = and meat=20 for an organism that science has not confirmed as being the cause of = Crohn's in=20 humans, and the usage of this information." In the opinion of PARA, as = expressed=20 in a letter to Animal Health Association President-elect, "this = statement=20 presents USAHA as not only primarily self-serving, but further, is = blatantly=20 contemptuous of both its own member producers and the American public." = The=20 letter concludes "We at PARA are saddened that USAHA has chosen to be = part of=20 the problem rather than part of the solution."[346]

Gambling with Lives

The USAHA statement reveals the gamble the industry is willing to = take. In=20 Britain, when asked what the industry planned to do about = paratuberculosis,=20 spokespersons said that it was "something that bears watching"[347] but=20 that they "preferred to defer action" until paraTB is proven to cause = disease in=20 humans.[348] This sounded all too familiar to the British = public after=20 the mad cow debacle, where the beef industry made the same wager--and = lost.[349]=20 According to some social science studies, it was the British public = authorities'=20 decade-long insistence on the safety of beef that did the most damage to = the=20 public trust.[350]

The American dairy industry is similarly gambling not only with the = health of=20 consumers, but with their own financial health. The financial impact of = paraTB=20 is enormous;[351] paratuberculosis currently costs the American = livestock=20 industry over a billion dollars a year.[352] A=20 collapse in consumer confidence could raise that figure much higher. =

"If MAP is ultimately shown not to be the cause of Crohn's disease," = Chiodini=20 argues, "then the industries have taken the appropriate position of=20 'lip-service,' to give an image of concern."[353] If,=20 however,--as PARA phrased it in an open letter to the industry--"dairy = products=20 become associated with the dreadful, life-destroying disease known as = Crohn's=20 disease, your markets may also collapse and may never recover. The image = of=20 dairy foods as being necessary for good nutrition, carefully propagated = and=20 nurtured by you for decades, may be destroyed."[354]

Other Dairy Products

It's not enough to test milk; we need to test other dairy products as = well.=20 One third of cheese produced in the US is made from raw unpasteurized = milk, in=20 which one could expect the highest levels of paraTB bacteria.[355] Cheese=20 manufacturers rely on the salty acidic environment of cheese to inhibit=20 bacterial growth,[356] but MAP is resistant to such conditions.[357] Even=20 less robust mycobacteria can survive in soft cheese for at least 3 = months and in=20 hard cheese for up to 10 months.[358]=20 Reportedly, at the University of Wisconsin, there is currently a = research=20 project which is investigating the survival of Mycobacterium = paratuberculosis in=20 cheese.[359]

Since MAP can survive freezing for at least a year,[360]=20 products such as ice cream may also be implicated.[361] Ice=20 cream may also come from less rigorously pasteurized milk.[362] Other=20 dairy products like butter, yogurt, and infant formula must also be high = research priorities.[363]

Beef

The standard veterinary recommendation when a cow is diagnosed with = Johne's=20 is to have her sent to slaughter. Beef from Johne's cattle is not = prevented from=20 being sold for human consumption because paratuberculosis is not = officially=20 considered a human pathogen. End-stage animals, their bodies dripping = with=20 literally trillions of paratuberculosis bacteria, are ground straight = into=20 hamburger meat.[364] When Crohn's patient advocates found out that = infected=20 tissue from animals with severe clinical paratuberculosis were funneled = into the=20 human food supply they were described as, not surprisingly, "abhorred = and=20 nauseated."[365]

In the advanced stages of Johne's Disease, MAP bacteria course = through the=20 cow's blood stream, infecting her internal organs, and potentially her = muscle=20 tissue. Even if the muscle tissue didn't contain large numbers of MAP = before the=20 infected cow's death, when she's slaughtered it seems impossible to = ensure that=20 feces do not contaminate the various tissues that are taken from her, as = evidenced by the numerous E. coli food poisoning deaths in recent = years.[366] As a=20 scientist put it: "Consequently, both preharvest and postharvest = contamination=20 of food products originating from cattle is plausible."[367]

Although Americans eat 2.6 billion pounds of culled dairy cows = annually, most=20 hamburger meat comes from cattle raised for beef. In 1984, about one = percent of=20 US beef cattle were found positive for Johne's Disease. Research is = ongoing at=20 the USDA to determine the current prevalence of Johne's Disease in beef = cattle,=20 but since Johne's is such a hidden disease, is not reportable, and is = not the=20 subject of a mandatory control program, one might suspect that the = incidence has=20 increased significantly as it has in the dairy cattle population.[368] In=20 spite of this situation, lack of awareness among beef producers is even = greater=20 than in dairy producers. The USDA Center for Animal Health Monitoring = reports=20 that 69.8% of US beef producers "had not heard of it [Johne's] before." = And less=20 then 10% of producers had any knowledge beyond name recognition.[369]

MAP bacteria probably survive standard cooking temperatures. = Mycobacterium=20 paratuberculosis is the most heat resistant mycobacterium present in = retail=20 beef.[370]=20 Even well cooked meat may contain live paraTB. The USDA recommends that=20 hamburgers be cooked to 71o Celsius (160o F). An unpierced roast or = steak need=20 only reach an internal temp of 63o C (145o F). Studies show prolonged = exposure=20 to at least 74o (165o F) may be necessary to eliminate the = paratuberculosis=20 bug.[371]=20 Mycobacterium paratuberculosis is also resistant to nitrites and the = smoking=20 process used in sausage production.[372] MAP may=20 contaminate other meats as well--paratuberculosis is suspected in pigs = and=20 chickens.[373]

Milk may be more dangerous to consume than meat, though, in regards = to=20 paratuberculosis. MAP is thought to survive digestion when carried in a = vehicle=20 like milk, because--as designed by nature--milk buffers the stomach = environment=20 to a near-neutral pH. In meat however, MAP's ability to survive = digestion by=20 stomach acid is less certain.

Water

Municipal water supplies must also be assessed for risk because = surface=20 waters contaminated by agricultural run-off feed the domestic water = supplies of=20 many communities in the US.[374] One of the reasons why paraTB has been called a = "superbug"=20 is because of its ability to survive in the environment for prolonged = periods.[375]=20 Mycobacteria like paraTB have survived on this planet for over a billion = years=20 which has allowed them to adapt.[376] In the=20 environment, MAP has a thick waxy cell wall which protects it[377]--it can=20 last for 9 months in mud,[378] and almost year in manure[379] and two=20 years in water. Standard domestic water treatment such as filtration and = chlorination are probably ineffective against paraTB.[380]

There have been a few disconcerting[381] reports=20 of MAP bacteria cultured from drinking water, both in Europe[382] and=20 from the water supply of a major American city.[383]=20 Europe's Drinking Water Inspectorate has commissioned a study into the=20 distribution and fate of MAP in drinking water treatment;[384] the=20 same inquiry should be happening here.

2000

The development last year with the most serious ramifications was = published=20 in the April 2000 issue of the American Journal of = Gastroenterology.=20 Knowing that cows with Johne'sdisease shed paratuberculosis into their = breast=20 milk, researchers wondered whether paratuberculosis bacteria could be = detected=20 in the milk of human mothers with Crohn's disease. Researchers also knew = that=20 there were reports of mothers with other mycobacterial diseases like = leprosy=20 shedding bacteria into their milk. So they examined two mothers with = Crohn's who=20 had just given birth and found paratuberculosis bacteria growing in both = the=20 mothers' breast milk, but not in the breast milk from control mothers = without=20 Crohn's. While breast feeding has not been found to be a risk factor for = Crohn's=20 and may actually have a protective effect,[385] the=20 presence of MAP in the breast milk of mothers with Crohn's not only adds = support=20 to the role of MAP in the pathogenesis of Crohn's disease,[386] but=20 shows how new generations could be exposed to paraTB.[387]

Recommendations for Action

Despite the fact that M. paratuberculosis is now a known human = pathogen, it=20 continues to be tolerated in our food supply.[388] After=20 finding of MAP in their retail milk supply, the Food Safety Authority of = Ireland=20 now requires that cattle infected with Johne's be excluded from the food = supply.=20 The flesh from an infected cow is no longer considered fit for human = consumption=20 and her milk is simply dumped.[389] Karen=20 Meyer of PARA commented, "The government of Ireland is to be commended = for=20 exercising the precautionary principle. Instead of trying to sweep the = problem=20 under the rug, they acted swiftly to give human health priority over = special=20 interests."[390]

The paratuberculosis problem in Ireland is minimal compared to that = of the=20 United States. According to the Chief Executive of the Food Safety = Authority, of=20 the 7.6 million cattle in Ireland, there are only 12 reported cases of = Johne's=20 disease. Nineteen percent of Irish retail milk samples grew out live = paraTB and=20 researchers only found12 cases of Johne's disease in the entire country. = Obviously, as the Food Safety Authority concedes, this may be an = underestimate,=20 but in the United States the paratuberculosis problem is exponentially = worse.=20 The estimated prevalence in the US is some 20,000 times greater than = that of=20 Ireland.[391]

If any country should be preventing contamination of the human food = supply it=20 should be the United States, which has the highest prevalence of Johne's = disease=20 in the world.[392] At their Fall 2000 meeting, however, the = National Johne's=20 Working Group continued to propose only voluntary measures to protect = cattle=20 health and no measures to protect human health.[393] The=20 removal of clinically infected animals from the human food supply alone = has been=20 modeled as having a highly significant impact.[394] This=20 could evidently be accomplished with relative ease, but as yet there has = been=20 little effort to do so.[395] When asked how long it would take to clean up = America's=20 herds if suddenly no milk from Johne's-positive cows could be sold, one = Johne's=20 Disease Committee member said "About six months."[396]

The consumer movement also needs to fight to make Crohn's a = reportable=20 illness.[397] The official FDA stance that pasteurization = eliminates MAP=20 is no longer tenable and must be continuously confronted with the = British retail=20 milk studies which put an end to the pasteurization debate once and for = all. An=20 extensive Freedom of Information Act search must be initiated to unearth = suppressed documents. For example, seven years ago Canada's agriculture=20 department produced a food safety risk assessment paper concluding that = the=20 paraTB-Crohn's link was something about which to be concerned. The = document,=20 however, was stamped "Protected. Not for Distribution" and was as such = buried.[398] These=20 are the kinds of documents the consumer movement needs to get a hold of. =

In Dr. Hermon-Taylor's view, "There is overwhelming evidence that we = are=20 sitting on a public health disaster of tragic proportions."[399]=20 Europe's Scientific Committee on Animal Health and Animal Welfare, = however,=20 concluded that the currently available evidence was insufficient to = confirm or=20 disprove the theory.[400] This uncertainly should not impede the = government from=20 taking concrete steps to prevent further potential human catastrophe. If = the=20 British government had acknowledged the precautionary principle, = millions of=20 lives may have been saved. A headline in The Times sums up an = inquiry=20 into the mishandling of the mad cow affair released last year in = Britain: "Lack=20 of Proof Led to Disaster."[401]

The precautionary principal is the basis for most European = environmental law=20 and is playing an increasingly important role in health policies = worldwide.[402]=20 Basically it states "If one has a reasonable suspicion that something = bad might=20 be going to happen, one has an obligation to try to stop it."[403] An=20 ounce of prevention is worth a pound of cure.

On a Personal Level

On a personal level, the Crohn's advocacy group Action Research = recommends=20 that people who want to reduce their risk of infection or=20 reinfection--especially those with Crohn's disease, or their close = relatives=20 (who might be genetically pre-disposed)--should stop eating dairy = products=20 unless they are effectively boiled first.[404] PARA=20 recommends that cheese should be heated to the temperature of boiling = water,=20 100o C (212o F), to reduce the threat. Thus, grilling cheese under = direct heat=20 for a few minutes (so that it "bubbles"), or cooking it in oven-baked = meals,=20 such as oven-baked lasagna, should effectively sterilize the cheese. The = same=20 applies to other dairy products, such as milk, yogurt or butter.[405]

The reason the industry doesn't pasteurize all milk at that = temperature to be=20 safe, is because it could affect the taste of the milk. As the Irish = Food Safety=20 Authority put it, "there is an upper temperature beyond which = unacceptable=20 changes to the taste of milk start to occur."[406] Steve=20 Merkel of PARA would have governments mandate raising the minimum = pasteurization=20 temperature to levels that ensured safety regardless, "even if it means = that=20 milk doesn't taste the same as it did. Human health must take precedence = over=20 taste."[407]

Stricter pasteurization may not be the answer, though. Although there = is=20 recent evidence that living MAP bacteria cause Crohn's,[408] even=20 dead MAP may be able to trigger disease.[409] For=20 example, one of the reasons that the vaccine for Johne's is so seldom = used is=20 because it is so dangerous to handle.[410] Even=20 though the vaccine is made out of killed MAP bacteria, the human immune = system=20 can react so violently just to the presence of MAP proteins, that = accidentally=20 injected into humans (or purposefully into other primates), the MAP = vaccine=20 causes a chronic progressive inflammation which can last for years[411] or may=20 even necessitate amputation of the injection site.[412] Closely=20 related bugs like leprosy can have similar effects.[4133] So=20 even if MAP is pasteurized to death, drinking the remnants of the = bacteria may=20 still cause a problem.

With this in mind, it may be more prudent to avoid dairy altogether. = Although=20 ingesting relatively few organisms may be able to cause infection, the = human=20 infective dose is not known.[414] It is=20 also not known how heavily the milk supply is contaminated in this = country. The=20 most esteemed pediatrician of all time, Dr. Benjamin Spock, advised that = children be raised vegan, with zero exposure to dairy products for a = variety of=20 reasons.[415] Especially considering the risk of = paratuberculosis in=20 milk, this would seem sensible advice, particularly for children and=20 adolescents.[416] There is a wide variety of dairy product = substitutes--soy=20 and rice milks, cheeses, ice cream, yogurt, etc.--making animal derived = dairy=20 products unnecessary.

Conclusion

The epidemic of Johne's disease, like that of mad cow disease, is an=20 indictment of factory farming.[417]=20 Intensive confinement systems in animal agriculture have been accused of = not=20 only threatening the global environment, but public health as well.[418] The=20 unnatural concentration of animals raised for slaughter, for example, = has led to=20 other human tragedies including the single worst epidemic in recorded = world=20 history, the 1918 influenza pandemic.[419] In that=20 case, the unnatural density and proximity of pigs and ducks raised for = slaughter=20 led to the deaths of upwards of 40 million people.[420]

This potential crisis is also an indictment of an industry that = continues to=20 risk public safety and a government that seems to protect business = interests=20 over those of the consumer. As Karen Meyer recently told the LA = Times,=20 "There comes a point in time where consumer health takes precedence over = commercial concerns."[421]

Every few hours, another child in this country is diagnosed with = Crohn's=20 disease and may be condemned to a life of chronic suffering.[422] The=20 balance of evidence strongly suggests a causative link between = Mycobacterium=20 paratuberculosis and Crohn's disease.423 This public health issue has = been at=20 the periphery of the dairy industry's agenda for years, a nagging = concern on the=20 back burner.[424] The consumer movement needs to move it to the = front burner=20 and needs to turn up the heat.

[1] Stark,=20 C. "New Foodborne Disease Estimates from CDC." Cornell Cooperative = Extension=20 Food and Nutrition September/October 1999.

[2] Centers=20 for Disease Control and Prevention. "CDC Surveillance Summaries." = MMWR=20 45(11996):35.

[3] Stark,=20 C. "Turkey Safety Information from USDA." Cornell Cooperative = Extension Food=20 and Nutrition November/December 1998.

[4] Glynn=20 MK, C Bopp, W Dewitt, et al. "Emergence of multidrug-resistant = Salmonella=20 enterica serotype typhimurium DT104 infections in the United States." = New=20 England Journal Medicine 338(1998):1333-8.

[5]=20 McDowell, RM and MD McElvaine. "Long-Term Sequelae To Foodborne = Disease." Office=20 of Risk Assessment and Animal and Plant Health inspection Cost-Benefit = Analysis.=20 United States Department of Agriculture.

[6] Ibid.=20

[7]=20 Chamberlain, L. "Media And Censorship A Project Censored Award is a = Dubious=20 Achievement." The Plain Dealer April 12-18, 2000

[8] Collins=20 MT. "M paratuberculosis in Foods and the Public Health Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:352.

[9]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[10]=20 Manning J. "Milk May be Linked to intestinal Illness." Milwaukee = Journal=20 Sentinel 6 September 1996:7.

[11]=20 United States Animal Health Association. "Report of the USAHA Committee = on Food=20 Safety." Monday, October 5, 1998 in Minneapolis, Minn.

[12]=20 Isselbacher KJ, et al. Harrison's Principles of Internal Medicine = Thirteenth edition. New York: McGraw Hill, 1994.

[13]=20 Maugh, TH. "Plenty of Relief... and Skepticism." Los Angeles = Times 18=20 September 2000:S1.

[14]=20 Clark S. "That Gut Feeling." Sunday Times 28 July 1996.

[15]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[16]=20 Chiodini RJ and CA Rossiter. "Paratuberculosis: A Potential Zoonosis?"=20 Veterinary Clinics of North America 12(1996):457-67.

[17] Lord=20 Greenway. "Crohn's Disease." Debate in the House of Lords. 19 Jun 2000. = Column=20 82.

[18]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:17.

[19]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[20]=20 Freyer FE. "Lawsuit: Hospital thwarted Disease research." The = Providence=20 Journal-Bulletin October 9, 1994:1B.

[21]=20 Chiodini RJ and CA Rossiter. "Paratuberculosis: A Potential Zoonosis?"=20 Veterinary Clinics of North America 12(1996):457-67.

[22]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:23.

[23]=20 Loftus EV, et al. "Crohn's Disease in Olmsted County, Minnesota, = 1940-1993:=20 Incidence, Prevalence, and Survival." Gastroenterology=20 114(19998):1161-1168.

[24]=20 Hermon-Taylor, J, et al. "Mycobacteria and the Aetiology of Crohn's = Disease."=20 Inflammatory Bowel Disease 1994. http://iol.ie/alank/CROHNS/paratub.htm. =

[25]=20 Loftus EV, et al. "Crohn's Disease in Olmsted County, Minnesota, = 1940-1993:=20 Incidence, Prevalence, and Survival." Gastroenterology=20 114(19998):1161-1168.

[26]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:14.

[27]=20 Chiodini RJ. "Mycobacterium paratuberculosis." Second International=20 Colloquium on Paratuberculosis International Society for = Paratuberculosis.=20 1988:141-5.

[28]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[29]=20 Dalziel TK. "Chronic Interstitial Enteritis." British Medical = Journal 25=20 October 1913:1058-70.

[30]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[31]=20 Chiodini RJ. "Mycobacterium paratuberculosis." Second International=20 Colloquium on Paratuberculosis International Society for = Paratuberculosis.=20 1988:141-5.

[32]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[33]=20 Dalziel TK. "Chronic Interstitial Enteritis." British Medical = Journal 25=20 October 1913:1058-70.

[34]=20 Sweeney RW. "Transmission of Paratuberculosis." Veterinary Clinics of = North=20 America 12(1996):305-11.

[35]=20 Paratuberculosis Awareness & Research Association. "MAP in food: The = case=20 for retail testing." Presented to the Food Safety Committee of the = United States=20 Animal Health Association in October 1998.=20 http://www.crohns.org/foodsafety/retail.htm.

[36]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Is Crohn's Disease a=20 Mycobacterial Disease? CJJ Mulder and GNJ Tytgat (Ed.) Dordrecht, = The=20 Netherlands: Kluwer Academic Publishers, 1992.

[37]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[38]=20 "Infective Agents - Mycobacteria." Inflammatory Bowel Disease = 1997:-131.=20

[39]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[40]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[41]=20 Andus T, et al. "Etiology and Pathophysiology of Inflammatory Bowel = Disease."=20 Hepato-Gastroenterology 47(2000):29-43.

[42]=20 Chiodini RJ and CA Rossiter. "Paratuberculosis: A Potential Zoonosis?"=20 Veterinary Clinics of North America 12(1996):457-67.

[43]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[44]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[45]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[46]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[47]=20 Hermon-Taylor, J. "The Causation of Crohn's Disease and Treatment with=20 Antimicrobial Drugs." Italian Journal of = Gastroenterology-Hepatology.=20 1998 Dec;30(6):607-10.

[48]=20 El-Zaatari and DY Graham. "Mycobacterial Etiology of Crohn's Disease." = Is=20 Crohn's Disease a Mycobacterial Disease? CJJ Mulder and GNJ Tytgat = (Ed.)=20 Dordrecht, The Netherlands: Kluwer Academic Publishers, 1992.

[49]=20 Chiodini RJ and CA Rossiter. "Paratuberculosis: A Potential Zoonosis?"=20 Veterinary Clinics of North America 12(1996):457-67.

[50]=20 Ibid.

[51]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[52]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[53]=20 Chiodini RJ. "Crohn's Disease and the Mycobacterioses." Clinical=20 Microbiological Reviews 2(1989):90-117.

[54]=20 Hermon-Taylor J, et al. "Mycobacterium paratuberculosis Cervical = Lymphadenitis=20 Followed Five Years Later By Terminal Ileitis Similar to Crohn's = Disease."=20 British Medical Journal February 7th 1998.

[55]=20 Engstrand L. "Mycobacterium Paratuberculosis and Crohn's Disease."=20 Scandinavian Journal of Infectious Disease 98(1995):27-9s.

[56]=20 Paratuberculosis Awareness and Research Association. "Scientific facts = about=20 Mycobacterium paratuberculosis and Crohn's."=20 http://members.aol.com/ParaTBweb/crohn.htm

[57]=20 Hermon-Taylor J. "Mycobacterium Paratuberculosis as a Chronic Enteric = Pathogen=20 in Humans." Fourth International Colloquium on Paratuberculosis = Chiodini=20 RJ, Collins MT and EOE Bassey, eds. Cambridge, UK: International = Association for=20 Paratuberculosis, 1994:174-80.

[58]=20 Kennedy, A. "Biopsy studies of Crohn's Disease."=20 http://www.iol.ie/alank/CROHNS/biopsy.htm

[59]=20 Hermon-Taylor J. "Mycobacterium Paratuberculosis as a Chronic Enteric = Pathogen=20 in Humans." Fourth International Colloquium on Paratuberculosis = Chiodini=20 RJ, Collins MT and EOE Bassey, eds. Cambridge, UK: International = Association for=20 Paratuberculosis, 1994:174-80.

[60]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[61]=20 Hermon-Taylor J. "Mycobacterium Paratuberculosis as a Chronic Enteric = Pathogen=20 in Humans." Fourth International Colloquium on Paratuberculosis = Chiodini=20 RJ, Collins MT and EOE Bassey, eds. Cambridge, UK: International = Association for=20 Paratuberculosis, 1994:174-80.

[62]=20 Shafran, et al. "Identification of Mycobacterium avium ss. = Paratuberculosis in=20 Crohn's Disease." Gut 46(2000):A324.

[63]=20 Hermon-Taylor, J, et al. "Mycobacteria and the Aetiology of Crohn's = Disease."=20 Inflammatory Bowel Disease 1994. = http://iol.ie/alank/CROHNS/paratub.htm.=20

[64]=20 McDowell, RM and MD McElvaine. "Long-Term Sequelae To Foodborne = Disease." Office=20 of Risk Assessment and Animal and Plant Health inspection Cost-Benefit = Analysis.=20 United States Department of Agriculture.

[65]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:12.

[66]=20 Hermon-Taylor, J, et al. "Mycobacteria and the Aetiology of Crohn's = Disease."=20 Inflammatory Bowel Disease 1994. = http://iol.ie/alank/CROHNS/paratub.htm.=20

[67]=20 "History of Johne's Disease." = http://www.vetmed.wisc.edu/pbs/johnes/history.html=20 February 19, 1997.

[68]=20 Schwartz D, et al. "Mycobacterium avium ss paratuberculosis In Crohn's = Disease=20 Tissue Is an Affirmative!" Gastroenterology. 99th American = Society of=20 Microbiology General Meeting: Atlanta, Georgia May 1999.

[69]=20 "Some Cases of Crohn's Disease Appear to Respond to Antibiotic = Treatment."=20 Infectious Disease News July 1996.

[70]=20 paratuberculosis from Breast Milk of Crohn's Disease Patients." = American=20 Journal of Gastroenterology 95(2000):)1094-5.

[71]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:30.

[72]=20 Ibid:40.

[73]=20 Ibid:39.

[74] Wall=20 S, et al. "identification of Spheroplast-like Agents Isolated from = Tissues of=20 Patients with Crohn's Disease and Control Tissues by Polymerase Chain = reaction."=20 Journal of Clinical Microbiology 31(1991):1241-5.

[75]=20 Chiodini RJ and CA Rossiter. "Paratuberculosis: A Potential Zoonosis?"=20 Veterinary Clinics of North America 12(1996):457-67.

[76]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[77]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[78]=20 Prantera C, et al. "Crohn's Disease and Mycobacteria." Biomedicine = and=20 Pharmacotherapy 43(1989):295-9.

[79]=20 Hermon-Taylor, J. "The Causation of Crohn's Disease and Treatment with=20 Antimicrobial Drugs." Italian Journal of = Gastroenterology-Hepatology 1998=20 Dec;30(6):607-10.

[80]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[81]=20 Seldenrikj CA, et al. "T-Cellular Immune Reactions (in Macrophage = Inhibition=20 Factor Assay) Against Mycobacterium paratuberculosis, Mycobacterium = Kansassii,=20 Mycobacterium tuberculosis, Mycobacterium avium in Patients with Chronic = Inflammatory Bowel Disease." Gut 31(1990):529-35.

[82]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[83]=20 Targan SR and LK Murphy. "Clarifying the Causes of Crohn's." Nature=20 Medicine 1(1995):1241-3.

[84]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[85] Moss=20 MT, et al. "Polymerase Chain Reaction Detection of Mycobacterium=20 paratuberculosis and Mycobacterium avium subsp silvaticum in Long Term = Cultures=20 from Crohn's Disease and Control Tissues." Gut 33(1992):1209-13. =

[86]=20 Brown ST, et al. "Mycobacterium paratuberculosis in Crohn's Disease."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:316-23.

[87]=20 Lober, B. "Are All Diseases Infectious?" Annals of Internal = Medicine 15=20 November 1996. 125:844-851.

[88] See,=20 for example, Tom Regan's book The Case for Animal Rights.

[89]=20 Monmaney, T. "Marchall's Hunch." New Yorker 20 September = 1993:64-72.

[90]=20 Mishina D, et al. "On the Etiology of Crohn Disease." Proceedings = National=20 Academy of Sciences 93(1996):9816-9820.

[91]=20 Paratuberculosis Awareness and Research Association. "Scientific facts = about=20 Mycobacterium paratuberculosis and Crohn's."=20 http://members.aol.com/ParaTBweb/crohn.htm

[92]=20 Morgan KL. "Johne's and Crohn's." The Lancet 2 May 1987:1017-9. =

[93] van=20 Kruiningen HJ, et al. "Experimental Disease in Infant Goats Induced by a = Mycobacterium Isolated from a patient with Crohn's Disease." = Digestive=20 Diseases and Sciences 31(1986):1351-60.

[94]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[95]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[96]=20 Sartor, RB. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:366-373.

[97]=20 Filder HM, et al. "Specific Detection of Mycobacterium paratuberculosis = DNA=20 Associated with Granulomatous Tissue in Crohn's Disease." Gut=20 35(1994):506-10.

[98]=20 Stainsby KJ, et al. "Antibodies to Mycobacterium paratuberculosis and = Nine=20 Species of Environmental Mycobacteria in Crohn's Disease and Control = Subjects."=20 Gut 34(1993):371-4.

[99]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[100]=20 Shafran, et al. "Humaoral Immune Response of Crohn's Patients for = Mycobacterium=20 avium Subspecies paratuberculosis." Gut 46(2000):A9.

[101]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[102]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:53.

[103]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[104]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[105]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[106]=20 Collins, MT and EJB Manning. "Johne's Disease: The International = Perspective."=20 Department of Pathobiological Sciences. University of Wisconsin School = of=20 Veterinary Medicine Madison, Wisconsin.

[107]=20 Sartor, RB. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:366-373.

[108]=20 Jones PH, et al. "Chronic Gastrointestinal Diseases in Dairy Farmers in = England=20 and the Welsh Borders: Is there an Association Between Crohn's Disease = and=20 Bovine Paratuberculosis?" 9th Symposium for the International Society = for=20 Veterinary Epidemiology and Economics, August 6-11 in Breckenridge,=20 Colorado, 2000.

[109]=20 Atkins P and P Brassley. "Mad Cow and Englishmen." History Today=20 46(1996):14.

[110]=20 "Zoonotic Potential of Johne's Disease: Association of M. = paratuberculosis and=20 Crohn's Disease." http://www.vetmed.wisc.edu/pbs/johnes/zoonoses.html = February=20 19, 1997.

[111]=20 Suenaga K, et al. "Serum Antibodies to Mycobacterium paratuberculosis in = Patients with Crohn's Disease." Digestive Diseases & Sciences=20 44(1999):1202-7.

[112]=20 Rose JDR, et al. "Cardiff Crohn's Disease Jubilee." Gut = 29(1988):346-51.=20

[113]=20 Hermon-Taylor J. "Mycobacterium Paratuberculosis as a Chronic Enteric = Pathogen=20 in Humans." Fourth International Colloquium on Paratuberculosis = Chiodini=20 RJ, Collins MT and EOE Bassey, eds. Cambridge, UK: International = Association for=20 Paratuberculosis, 1994:174-80.

[114]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[115]=20 Hermon-Taylor J, et al. "Mycobacterium paratuberculosis Cervical = Lymphadenitis=20 Followed Five Years Later By Terminal Ileitis Similar to Crohn's = Disease."=20 British Medical Journal February 7th 1998.

[116]=20 Maugh II, TH. "Spreading a New Idea on Disease: Mounting Evidence May = Link=20 Viruses And Bacteria to Everything from Gallstones to Alzheimer's." = LA=20 Times http://www.sonic.net/melissk/spreadin.html 1999.

[117]=20 "Crohn's Disease May Be Caused By Bacteria Similar to TB Microbe."=20 Biotechnology Newswatch July 5, 1999:5.

[118]=20 Monmaney, T. "Marchall's Hunch." New Yorker 20 September = 1993:64-72.

[119]=20 Maugh II, TH. "Spreading a New Idea on Disease: Mounting Evidence May = Link=20 Viruses And Bacteria to Everything from Gallstones to Alzheimer's." = LA=20 Times http://www.sonic.net/melissk/spreadin.html 1999.

[120]=20 "Helicobacter pylori in Peptic Ulcer Disease." NIH Consensus Statement = 1994 Jan=20 7-9;12(1):1-23.

[121]=20 Lorber B. "Are All Diseases Infectious?" Annals of Internal = Medicine=20 125(1996):844-51.

[122]=20 Monmaney, T. "Marchall's Hunch." New Yorker 20 September = 1993:64-72.

[123]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[124]=20 Lober, B. "Are All Diseases Infectious?" Annals of Internal = Medicine 15=20 November 1996. 125:844-851.

[125]=20 Hulten K. "Antibacterial Therapy for Crohn's Disease: A Review = Emphasizing=20 Therapy Directed Against Mycobacteria." Digestive Diseases and = Sciences=20 45(2000):445-56.

[126]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:46.

[127]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Mulder and Tytgat GNJ (eds): = Is=20 Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer Academic=20 Publishers, 1992, pp 1-15.

[128]=20 Rampton DS. "Management of Crohn's Disease." British Medical = Journal=20 319(1999):1480.

[129]=20 Fishman SJ, et al. "Thalidomide Therapy for Crohn's Disease."=20 Gastroenterology 199(2000):596-602.

[130]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:46.

[131]=20 Brown ST, et al. "Mycobacterium paratuberculosis in Crohn's Disease."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:316-23.

[132]=20 United States Animal Health Association. "Report of the USAHA Committee = on Food=20 Safety." Monday, October 5, 1998 in Minneapolis, Minn.

[133]=20 Chiodini RJ. "Crohn's Disease and the Mycobacterioses." Clinical=20 Microbiological Reviews 2(1989):90-117.

[134]=20 Chiodini RJ. "Historical Overview and Current Approaches in Determining = a=20 Mycobacterial Etiology of Crohn's Disease." Is Crohn's Disease a=20 Mycobacterial Disease? CJJ Mulder and GNJ Tytgat (Ed.) Dordrecht, = The=20 Netherlands: Kluwer Academic Publishers, 1992.

[135]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[136]=20 Chiodini RJ. "Crohn's Disease and the Mycobacterioses." Clinical=20 Microbiological Reviews 2(1989):90-117.

[137]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:46.

[138]=20 Hornick DB. "Nontuberculous Mycobacterial Lung Disease." Chest = 93(1988):550-5.=20

[139]=20 Chiodini, RJ. "Antimicrobial Agents and Crohn's Disease: Do they have a=20 therapeutic role?" Italian Journal of Gastroenterology-Hepatology = 1998=20 Dec;30(6):593-8

[140]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[141]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:17.

[142]=20 Hulten K. "Antibacterial Therapy for Crohn's Disease: A Review = Emphasizing=20 Therapy Directed Against Mycobacteria." Digestive Diseases and = Sciences=20 45(2000):445-56.

[143]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:48.

[144]=20 Ibid.

[145]=20 Gui, GPH, et al. "Two-year Outcomes Analysis of Crohn's Disease Treated = with=20 Rifabutin and Macrolide Antibiotics." Journal of Antimicrobial=20 Chemotherapy 1997 Mar;39(3):393-400.

[146]=20 Ibid.

[147]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:48.

[148]=20 Gui, GPH, et al. "Two-year Outcomes Analysis of Crohn's Disease Treated = with=20 Rifabutin and Macrolide Antibiotics." Journal of Antimicrobial=20 Chemotherapy 1997 Mar;39(3):393-400.

[149]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[150]=20 Gui, GPH, et al. "Two-year Outcomes Analysis of Crohn's Disease Treated = with=20 Rifabutin and Macrolide Antibiotics." Journal of Antimicrobial=20 Chemotherapy 1997 Mar;39(3):393-400.

[151]=20 Ibid.

[152]=20 Brody, TJ, et al. "Treatment of Severe Crohn's Disease Using=20 Rifabutin-Macrolide-Clofazimine Combinations: Interim Report." = American=20 Journal of Gastroenterology 114(4):G3842.

[153]=20 Douglas A. "An Open Pilot Study of Antimicrobial Therapy in Patients = with=20 Unresponsive Crohn's Disease." Gut 46(2000):A11.

[154]=20 Borody, TJ, et al. "Treatment of Severe Crohn's Disease(CD) Using=20 Rifabutin-Macrolide-Clofazamine Comnibation: Results at 30-37 months."=20 Gut 46(2000):A1334.

[155]=20 Cann, PA and MG Bramble. "An Open Pilot Study of Antimicrobial Agents in = the=20 Management of Resistant Crohn's Disease." Gut 46(2000):A1335. =

[156]=20 Shafran I, et al. "Rifabutin and Macrolide Antibiotic Treatment in = Crohn's=20 Patients Identified Serologically Positive for Mycobacterium avium ss.=20 paratuberculosis." Gut 46(2000):A782.

[157]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[185]=20 "Some cases of Crohn's Disease appear to respond to antibiotic = treatment:=20 Evidence suggests that a mycobacterium has a role in the illness; = investigators=20 have tested clarithromycin alone and in combination with rifabutin."=20 Infectious Disease News July 1996.

[159]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[160]=20 Brooks, A. "Quality of UK Milk to be Studied." British Medical = Journal=20 317(1998):491.

[161]=20 Shafran, et al. "Endoscopic Healing of Crohn's After Antibiotic = Treatment."=20 Gut 46(2000):A9.

[162]=20 Maugh, TH. "Plenty of Relief... and Skepticism." Los Angeles = Times 18=20 September 2000:S1.

[163]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[164]=20 This may be particularly important in that the subjects were also given=20 probiotics (like acidophilus) which may confound the results per = (Suenaga K, et=20 al. "Serum Antibodies to Mycobacterium paratuberculosis in Patients with = Crohn's=20 Disease." Digestive Diseases & Sciences 44(1999):1202-7.)

[165]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[166]=20 Ibid.

[167]=20 Ibid.

[168]=20 Monmaney, T. "Marchall's Hunch." New Yorker 20 September = 1993:64-72.

[169]=20 "Scientific Findings." http://www.crohns.org/research/index.htm

[170]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:53.

[171]=20 Paratuberculosis Awareness & Research Association. "Phase III = clinical trial=20 of anti-paratuberculosis antibiotic therapy begins in Australia."=20 http://www.crohns.org/research/austrial.htm, 1999.

[172]=20 "Mycobacterium Paratuberculosis and Crohn's Disease:A = PatientCommunity.com=20 interview with Dr. Ira Shafran." PatientCommunity.com 19 October 2000. =

[173]=20 "Crohn's Disease May Be Caused by Bacteria Similar to TB Microbe."=20 Biotechnology Newswatch July 5, 1999:5.

[174]=20 Murray, I. "Crohn's Linked To Bacteria In Milk." The Times = (London)=20 January 25, 2000:Home News.

[175]=20 El-Zaatari and DY Graham. "Mycobacterial Etiology of Crohn's Disease." = Is=20 Crohn's Disease a Mycobacterial Disease? CJJ Mulder and GNJ Tytgat = (Ed.)=20 Dordrecht, The Netherlands: Kluwer Academic Publishers, 1992.

[176]=20 Lorber B. "Are All Diseases Infectious?" Annals of Internal = Medicine=20 125(1996):844-51.

[177]=20 Maugh II, TH. "Spreading a New Idea on Disease: Mounting Evidence May = Link=20 Viruses And Bacteria to Everything from Gallstones to Alzheimer's." = LA=20 Times http://www.sonic.net/melissk/spreadin.html 1999.

[178]=20 "Helicobacter pylori in peptic ulcer Disease." NIH Consensus Statement = 1994 Jan=20 7-9;12(1):1-23.

[179]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[180]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[181]=20 Boyce, N. "Milk Theory Stirs Up Bowel Disease Experts." New = Scientist=20 February 7th 1998.

[182]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[183]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:49.

[184]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[185]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:49.

[186]=20 Smith, KL and JS Hogan. "Milk Quality - A Worldwide Perspective." = Annual=20 Proceedings of the National Mastitis Council St. Louis, Missouri, = 1998.

[187]=20 Assuming a billion lymphocytes/ml as a reasonable defining concentration = of pus,=20 regulations per (Heeschen, W.H. 1997. Codex regulations and food safety. = Bulletin of the International Dairy Federation No.319/1997, pp 24.), a = standard=20 20 drops/ml, and a "glass" as 500 cc., Grade A milk may have more than = seven=20 drops of pus per glass.

[188]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:49.

[189]=20 Millar D, et al. "IS900 PCR to Detect Mycobacterium paratuberculosis in = Retail=20 Supplies of Whole Pasteurized Cow's Milk in England and Wales." = Applied and=20 Environmental Microbiology 62(1996):3446-52.

[190]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December.

[191]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:50-51.

[192]=20 Sung N and MT Collins. "Thermal Tolerance in Mycobacterium = paratuberculosis."=20 Applied and Environmental Microbiology 64(1998):999-1005.

[193]=20 Ibid.

[194]=20 Sung N, Kaspar CW2, and MT Collins. "Determination of D-values in = studies on the=20 thermal tolerance of Mycobacterium paratuberculosis." 5th Intl. Coll. = Paratuberculosis: Chiodini RJ, Hines II ME, Collins MT (eds), 1997. =

[195]=20 Lord McColl. "Crohn's Disease." Debate in the House of Lords. 19 Jun = 2000.=20 Column 82.

[196]=20 Grant IR, Ball HJ and MT Rowe. "Effect of higher pasteurization = temperatures,=20 and longer holding times at 72 degrees C, on the inactivation of = Mycobacterium=20 paratuberculosis in milk." Letters in Applied Microbiology. = 28(6):461-5,=20 1999 Jun.

[197]=20 United States Animal Health Association. "Report of the USAHA Committee = on Food=20 Safety." Monday, October 5, 1998 in Minneapolis, Minn.

[198]=20 Grant IR, Ball HJ2, and MT Rowe. "A novel staining technique for = assessing=20 clumping and viability of Mycobacterium paratuberculosis cells during=20 pasteurization." Proc. 5th Intl. Coll. Paratuberculosis: Chiodini = RJ,=20 Hines IIME, Collins MT (eds),1997.

[199]=20 Rampton S and J Stauber "Mad Cow U.S.A.: Could the Nightmare Happen = Here?" PR=20 Watch 4(1997).

[200]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[201]=20 Riemann HP and B Abbas. "Diagnosis and Control of Bovine = Paratuberculosis=20 (Johne's Disease)." Advances in Veterinary Science and Comparative=20 Medicine 27(1983):481-505.

[202]=20 Paratuberculosis Awareness & Research Association. "MAP in the = United=20 Kingdom." http://www.crohns.org/government/uk.htm, 1999.

[203]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[204]=20 Ibid.

[205] Kennedy, A. "The Prevalence of BJD (Bovine = Johne's=20 Disease)." http://www.iol.ie/alank/CROHNS/johne.htm

[206]=20 Nunes GC and RE Ahlquist, Jr. "Increasing Incidence of Crohn's Disease." = American journal of Surgery 145(1983):546-81.

[207]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[208]=20 Proceedings of the 1999 Cornell Nutrition Conference for Feed=20 Manufacturers Ithaca, NY: Dept. of Animal Science, 1999:130.

[209]=20 Ibid.

[210]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[211]=20 Cocito C, et al. "Paratuberculosis." Clinical Microbiology = Reviews=20 7(1994):328-45.

[212]=20 Kennedy, A. "The Prevalence of BJD (Bovine Johne's Disease)."=20 http://www.iol.ie/alank/CROHNS/johne.htm

[213]=20 "Johne's Disease--a Growing Threat to Dairymen." Hoard's Dairyman = 25=20 March 1981:456-60.

[214]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[215]=20 Crohn's & Colitis Foundation of America, Inc. "NIH Seeks Answers." = December=20 30, 1998. www.ccfa.org/news/news1230.htm

[216]=20 Hermon-Taylor, J, et al. "Mycobacteria and the Aetiology of Crohn's = Disease."=20 Inflammatory Bowel Disease 1994. = http://iol.ie/alank/CROHNS/paratub.htm.=20

[217]=20 Grant IR. "Does Mycobacterium paratuberculosis Survive Current = Pasteurization=20 Conditions?" Applied and Environmental Microbiology = 64(1988):2760.

[218]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[219]=20 Grant IR. "Does Mycobacterium paratuberculosis Survive Current = Pasteurization=20 Conditions?" Applied and Environmental Microbiology = 64(1988):2760.

[220]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[221]=20 Cerf O and MW Griffiths. "Mycobacterium paratuberculosis Heat = Resistance."=20 Letters in Applied Microbiology 30(2000):341-3.

[222]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[223]=20 Stabel JR, Steadham EM and CA Boilin. "Heat Inactivation of = Mycobacterium=20 paratuberculosis in Raw Milk: Are Current Pasteurization Conditions = Effective?"=20 Applied and Environmental Microbiology 63(1997):4975-7.

[224]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[225]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[226]=20 Paratuberculosis Awareness & Research Association. "MAP in food: The = case=20 for retail testing." Presented to the Food Safety Committee of the = United States=20 Animal Health Association in October 1998.=20 http://www.crohns.org/foodsafety/retail.htm.

[227]=20 Paratuberculosis Awareness and Research Association. "World's foremost = research=20 minds target Crohn's Disease." January 4 1999.=20 http://www.crohns.org/media/pr040199.htm

[228]=20 Ibid

[229]=20 Grant IR, Ball HJ and MT Rowe. "Effect of high-temperature, short-time = (HTST)=20 pasteurization on milk containing low numbers of Mycobacterium=20 paratuberculosis."

[230]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[231]=20 Rossiter CA and WS Burhans. "Farm-specific Approach to Paratuberculosis = (Johne's=20 Disease) Control." Veterinary Clinics of North America = 12(1996):383.

[232]=20 Gutknecht, K. "A needling question: Does Pasteurization really kill M.=20 paratuberculosis?" Wisconsin Agriculturist July 1998

[233]=20 May 10, 1998 issue per (Business Wire. "Anti-Milk Group Exposes Claim = That=20 Normal Pasteurization Kills Dangerous Bacterium in Milk." July 14, = 1998.)

[234]=20 O'Sullivan K. "Food Group Says Irish Milk is Safe." The Irish Times 12 = August=20 1998:3.

[235]=20 Comerford C. "Milk in Link to Stomach Disease." The Independent (London) = 11=20 August 1998:2.

[236]=20 Hermon-Taylor, J. "The Causation of Crohn's Disease and Treatment with=20 Antimicrobial Drugs." Italian Journal of = Gastroenterology-Hepatology 1998=20 Dec;30(6):607-10.

[237]=20 Whalley, S. "Milk Drinkers Cool Over Health Scare." Reed Business = Information=20 August 14, 1998:8. www.reedbusiness.com/retail.htm

[238]=20 Freeman, M. "Angry reaction to Crohn's Disease allegation." Farmers=20 Guardian January 28, 2000:7.

[239]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[240]=20 Lord Greenway. "Crohn's Disease." Debate in the House of Lords. 19 Jun = 2000.=20 Column 82.

[241]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:50-51.

[242]=20 Maugh, TH. "Milk May be the Carrier of Crohn's." Los Angeles = Times 18=20 September 2000:S1.

[243]=20 Hermon-Taylor J. "Mycobacterium Paratuberculosis as a Chronic Enteric = Pathogen=20 in Humans." Fourth International Colloquium on Paratuberculosis = Chiodini=20 RJ, Collins MT and EOE Bassey, eds. Cambridge, UK: International = Association for=20 Paratuberculosis, 1994 :174-80.

[244]=20 Brown D. "Milk Heat Treatment Increased." The Daily Telegraph 12 = August=20 1998.

[245]=20 Lord Turnberg. "Crohn's Disease." Debate in the House of Lords. 19 Jun = 2000.=20 Column 82.

[246]=20 Hulse V. Mad Cows and Milk Gate Phoenix, OR: Marble Mountain = Publishing,=20 1996.

[247]=20 Stabel JR, Steadham EM and CA Boilin. "Heat Inactivation of = Mycobacterium=20 paratuberculosis in Raw Milk: Are Current Pasteurization Conditions = Effective?"=20 Applied and Environmental Microbiology 63(1997):4975-7.

[248]=20 Westcott S. "Minister 'confident' Over Safety of Milk." Press = Association=20 Newsfile April 2, 2000, Sunday.

[249]=20 Bleifuss, J. "A 21st Century Plague?; Britain's mad cows may harbinger = the=20 deaths of millions." In These Times 7 February 2000:2.

[250]=20 Tribune News Service. "Pasteurized Milk 'Safe.'" Chicago Tribune = 9=20 September 1996:3.

[251]=20 Maugh, TH. "Milk May be the Carrier of Crohn's." Los Angeles = Times 18=20 September 2000:S1.

[252]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[253]=20 Paratuberculosis Awareness and Research Association. "FDA Claims Milk = Safe,=20 Evades Farm Magazine Editor's Questions."=20 http://www.crohns.org/media/pr200798.htm

[254]=20 Please read Noam Chomsky's work on the duplicity of corporations and the = state.=20

[255]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[256]=20 Mason O, Rowe MT and HJ Ball. "Is Mycobacterium paratuberculosis a = possible=20 agent in Crohn's Disease? Implications for the Dairy Industry." Milk = Science=20 International 52(1997:311-6.

[257]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[258]=20 Chiodini RJ and HJ van Kruiningen. "The Prevalence of Paratuberculosis = in Culled=20 New England Cattle." Cornell Veterinarian 76(1986):91-104.

[259]=20 Riemann HP and B Abbas. "Diagnosis and Control of Bovine = Paratuberculosis=20 (Johne's Disease)." Advances in Veterinary Science and Comparative = Medicine=20 27(1983):481-505.

[260]=20 Stabel JR "Johne's Disease: A Hidden Threat." Journal of Dairy = Science=20 81(1998):283-288.

[261]=20 Proceedings of the 1999 Cornell Nutrition Conference for Feed=20 Manufacturers Ithaca, NY: Dept. of Animal Science, 1999:132. =

[262]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:9.

[263]=20 Ibid:21.

[264]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[265]=20 Whitlock RH and C Buergelt. "Preclinical and Clinical Manifestations of=20 Paratuberculosis (including Pathology). Veterinary Clinics of North=20 America 12(1996):345-55.

[266]=20 Pell AN. "Manure and Microbes." Journal of Dairy Science=20 80(1997):2673-81.

[276]=20 Whitlock RH and C Buergelt. "Preclinical and Clinical Manifestations of=20 Paratuberculosis (including Pathology). Veterinary Clinics of North=20 America 12(1996):345-55.

[268]=20 Crohn's & Colitis Foundation of America, Inc. "NIH Seeks Answers." = December=20 30, 1998. www.ccfa.org/news/news1230.htm

[269]=20 Hansen D and C Rossiter "Clinical description and epidemiology of = Johne's=20 Disease in cattle." National Johne's Working Group, a subcommittee of = the=20 Johne's Committee of the U. S. Animal Health Association.

[270]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[271]=20 Whitlock RH and C Buergelt. "Preclinical and Clinical Manifestations of=20 Paratuberculosis (including Pathology). Veterinary Clinics of North=20 America 12(1996):345-55.

[272]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:13.

[273]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[274]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[275]=20 Collins MT. "Diagnosis and Control of Paratuberculosis." Fourth = International=20 Colloquium on Paratuberculosis Chiodini RJ, Collins MT and EOE = Bassey, eds.=20 Cambridge, UK: International Association for Paratuberculosis, = 1994:325-44.

[276]=20 Richards WD. "Environmental Acidity may be the Missing Piece in the = Johne's=20 Disease Puzzle." Johne's Disease Milner AR and PR Wood eds. = Australia:=20 Csiro:99-103.

[277]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[278]=20 Rossiter CA and WS Burhans. "Farm-specific Approach to Paratuberculosis = (Johne's=20 Disease) Control." Veterinary Clinics of North America = 12(1996):383.

[279]=20 Proceedings of the 1999 Cornell Nutrition Conference for Feed=20 Manufacturers Ithaca, NY: Dept. of Animal Science, 1999:130.

[280]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[281]=20 Collins MT. "Diagnosis and Control of Paratuberculosis." Fourth = International=20 Colloquium on Paratuberculosis Chiodini RJ, Collins MT and EOE = Bassey, eds.=20 Cambridge, UK: International Association for Paratuberculosis, = 1994:325-44.

[282]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[283]=20 Ibid.

[284]=20 Highly esteemed Professor of Animal Science Temple Grandin describes the = practice in Oliver W. Sacks' An Anthropologist on Mars (1996): "That's = one sad,=20 unhappy, upset cow. She wants her baby, hunting for it. It's like = grieving,=20 mourning--not much written about it. people don't like to allow them = thoughts or=20 feelings."

[285]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[286]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[287]=20 Arbuthnot A. "Johne's Disease: a Dairy Industry Perspective." Johne's = Disease Milner AR and PR Wood eds. Australia: Csiro:99-103.

[288]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[289]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[290]=20 Galloway, JA. "USDA Reviewing Milk Safety Standards; Bacteria-Disease = Link=20 Examined." Wisconsin State Journal February 1, 1995:1A.

[291]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[292]=20 Collins MT. Mycobacterium paratuberculosis: A Food-Borne Pathogen?" = Journal=20 of Dairy Science 80(1997):3445-8.

[293]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[294]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[295]=20 Ibid.

[296]=20 Wells SJ, et al. "Johne's Disease on US Dairy Operations." = Proceedings of the=20 Fifth International Colloquium on Paratuberculosis Chiodini RK, = Hines ME,=20 and MT Collins (Eds.) Madison, WI: International Association for=20 Paratuberculosis, 1996:140-2.

[297]=20 Paratuberculosis Awareness and Research Association. "PARA Executive = Director=20 addresses Johne's Disease groups." November 24 1999.=20 http://www.crohns.org/media/pr241199.htm

[298]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[299]=20 Ibid.

[300]=20 Paratuberculosis Awareness and Research Association. "World's foremost = research=20 minds target Crohn's Disease." January 4 1999.=20 http://www.crohns.org/media/pr040199.htm

[301]=20 Sweeney RW. "Preface." Veterinary Clinics of North America = 12(1996).

[302]=20 Richards WD. "Environmental Acidity may be the Missing Piece in the = Johne's=20 Disease Puzzle." Johne's Disease Milner AR and PR Wood eds. = Australia:=20 Csiro:99-103.

[303]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[304]=20 Per (USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National = Animal=20 Health Monitoring System. October, 1997) an underestimate of 3.4% all = dairy cows=20 infected. Per (Dargatz D, et al. "What Do I Need to Know About Johne's = Disease=20 in Beef Cattle?" USDA:APHIS:VS. = http://www.aphis.usda.gov/vs/ceah/cahmN309.899=20 August 1999) .4% of all beef cattle infected. Per (Institute of = Medicine. The=20 Use of Drugs in Food Animals. Washington DC: National Academy Press, = 1999)10=20 million dairy cattle, 100 million beef cattle in the US.

[305]=20 Rossiter CA and WS Burhans. "Farm-specific Approach to Paratuberculosis = (Johne's=20 Disease) Control." Veterinary Clinics of North America = 12(1996):383.

[306]=20 Sweeney RW. "Transmission of Paratuberculosis." Veterinary Clinics of = North=20 America 12(1996):305-11.

[307]=20 Wells SJ. "Herd-Level Risk Factors for Infection with Mycobacterium=20 paratuberculosis in US Dairies and Association between Familiarity of = the Herd=20 Manager with the Disease or Prior Diagnosis of the Disease in that Herd = and Use=20 of Preventive Measures." Journal of the American Veterinary Medical=20 Association 216(2000):1450-7.

[308]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[309]=20 Sockett DC. "Johne's Disease Eradication and Control." Veterinary = Clinics of=20 North America 12(1996):431-39.

[310]=20 "Paratuberculosis Regulations Changed." Journal of the American = Veterinary=20 Medical Association 216(2000):1695.

[311]=20 Sockett DC. "Johne's Disease Eradication and Control." Veterinary = Clinics of=20 North America 12(1996):431-39.

[321]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[313]=20 Paratuberculosis Awareness and Research Association. "World's foremost = research=20 minds target Crohn's Disease." January 4 1999.=20 http://www.crohns.org/media/pr040199.htm

[314]=20 Rampton, S and J Stauber. Mad Cow USA: Could the Nightmare Happen Here. = Monroe,=20 ME: Common Courage Press, 1997.

[315]=20 Sockett DC. "Johne's Disease Eradication and Control." Veterinary = Clinics of=20 North America 12(1996):431-39.

[316]=20 Paratuberculosis Awareness and Research Association. "PARA Takes the = Case for=20 Retail Testing to USAHA(U.S. Animal Health Association)."=20 http://www.crohns.org/media/pr151098.htm

[317]=20 USDA: APHIS. "Johne's Disease on U.S. Dairy Operations." National Animal = Health=20 Monitoring System. October, 1997.

[318]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[319]=20 Bulaga LL and MT Collins. "U.S. Voluntary Johne's Disease Herd Status = Program=20 for Cattle." Proceedings of the Sixth International Colloquium on=20 Paratuberculosis: Manning EJB, Collins MT(eds) International = Association for=20 Paratuberculosis, 1999.

[320]=20 Sockett DC. "Johne's Disease Eradication and Control." Veterinary = Clinics of=20 North America 12(1996):431-39.

[321]=20 Ibid.

[322]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = paratuberculosis=20 in retail beef supplies." http://members.aol.com/ParaTBweb/beef.htm

[323]=20 Newsing J. "The Roast Beef of Old England." International Journal of = Health=20 Services 27(1997):243-6.

[324]=20 Paratuberculosis Awareness and Research Association. "PARA Executive = Director=20 addresses Johne's Disease groups." November 24 1999.=20 http://www.crohns.org/media/pr241199.htm

[325]=20 United States Animal Health Association. "Report of the USAHA Committee = on Food=20 Safety." Monday, October 5, 1998 in Minneapolis, Minn.

[326]=20 Paratuberculosis Awareness and Research Association. "Experts from = around the=20 world gather to discuss Paratuberculosis, Johne's Disease and Crohn's = Disease."=20 February 19 1999. http://www.crohns.org/media/colloq.htm

[327]=20 Rossiter CA. "On-Farm Control of Johne's Disease in Cattle Populations." = Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:132-9.

[328]=20 Hoy, A. "Disease threat to a million sheep." Sydney Morning Herald July = 30th=20 1997

[329]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[330]=20 United States Animal Health Association. "Report of the USAHA Committee = on Food=20 Safety." Monday, October 5, 1998 in Minneapolis, Minn.

[331]=20 Hulse V. Mad Cows and Milk Gate Phoenix, OR: Marble Mountain = Publishing,=20 1996.

[332]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[333]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[334]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[335]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[336]=20 Paratuberculosis Awareness and Research Association. "PARA Takes the = Case for=20 Retail Testing to USAHA(U.S. Animal Health Association)."=20 http://www.crohns.org/media/pr151098.htm

[337]=20 Paratuberculosis Awareness & Research Association. "MAP in food: The = case=20 for retail testing." Presented to the Food Safety Committee of the = United States=20 Animal Health Association in October 1998.=20 http://www.crohns.org/foodsafety/retail.htm.

[338]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[339]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[340]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1997.

[341]=20 Gutknecht, K. "A Needling Question: Does Pasteurization really kill M.=20 paratuberculosis?" Wisconsin Agriculturist July 1998

[342]=20 Paratuberculosis Awareness and Research Association. "PARA Takes the = Case for=20 Retail Testing to USAHA(U.S. Animal Health Association)."=20 http://www.crohns.org/media/pr151098.htm

[343]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[344]=20 Paratuberculosis Awareness and Research Association. "PARA Takes the = Case for=20 Retail Testing to USAHA(U.S. Animal Health Association)."=20 http://www.crohns.org/media/pr151098.htm

[345]=20 Ibid.

[346]=20 Ibid.

[347]=20 Paratuberculosis Awareness and Research Association. "World's foremost = research=20 minds target Crohn's Disease." January 4 1999.=20 http://www.crohns.org/media/pr040199.htm

[348]=20 Kennedy, Alan. "Does Mycobacteria Cause Crohn's Disease?"=20 http://www.iol.ie/alank/CROHNS/welcome.htm

[349]=20 Stuttaford, T. "Lack of Proof Led to Disaster." The Times 26 = October=20 2000:4.

[350]=20 Jaboc M and T Hellstrom. "Policy Understanding of Science, Public Trust = and the=20 BSE-CJD Crisis." Journal of Hazardous Materials 78(2000):303-17. =

[351]=20 Cocito C, et al. "Paratuberculosis." Clinical Microbiology = Reviews=20 7(1994):328-45.

[352]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist December.

[353]=20 Chiodini RJ. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:353-365.

[354]=20 Paratuberculosis Awareness and Research Association. "Mycobacterium=20 Paratuberculosis In Retail Dairy Supplies."=20 http://members.aol.com/ParaTBweb/dairy.htm

[355]=20 McDowell, RM and MD McElvaine. "Long-Term Sequelae To Foodborne = Disease." Office=20 of Risk Assessment and Animal and Plant Health inspection Cost-Benefit = Analysis.=20 United States Department of Agriculture.

[356]=20 Sung N1, Kaspar CW2, and MT Collins. "Kinetics Of Nonthermal = Inactivation Of=20 Mycobacterium paratuberculosis." 5th Intl. Coll. = Paratuberculosis:=20 Chiodini RJ, Hines IIME, Collins MT (eds) Year1997.

[357]=20 Ibid.

[358]=20 Institute for Food Science and technology. "Mycobacterium = paratuberculosis and=20 Milk." Food Science and Technology Today 12(1998):223-7.

[359]=20 Kennedy, A. "Why IBD sufferers should only consume UHT or Ultra = Pasteurized=20 dairy products." http://www.iol.ie/alank/CROHNS/uhtmilk.htm

[360]=20 Larsen AB, et al. "Survival Time of Mycobacterium Paratuberculosis." = American=20 Journal of Veterinary Research July 1956:549-51.

[361]=20 Chiodini RJ, et al. "Ruminant Paratuberculosis (Johne's Disease): The = Current=20 Status and Future Prospects." Cornell Veterinarian = 74(1984):218-262.

[362]=20 Paratuberculosis Awareness & Research Association. "MAP in food: The = case=20 for retail testing." Presented to the Food Safety Committee of the = United States=20 Animal Health Association in October 1998.=20 http://www.crohns.org/foodsafety/retail.htm.

[363]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = Paratuberculosis=20 In Retail Dairy Supplies." http://members.aol.com/ParaTBweb/dairy.htm =

[364]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = paratuberculosis=20 in retail beef supplies." http://members.aol.com/ParaTBweb/beef.htm

[365]=20 Paratuberculosis Awareness and Research Association. "World's foremost = research=20 minds target Crohn's Disease." January 4 1999.=20 http://www.crohns.org/media/pr040199.htm

[366]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = paratuberculosis=20 in retail beef supplies." http://members.aol.com/ParaTBweb/beef.htm

[367]=20 Collins MT. Mycobacterium paratuberculosis: A Food-Borne Pathogen?" = Journal=20 of Dairy Science 80(1997):3445-8.

[368]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = paratuberculosis=20 in retail beef supplies." http://members.aol.com/ParaTBweb/beef.htm

[369]=20 Dargatz DA, Wells SJ, and SL Ott. "Johne's Disease and U.S. Cow-calf=20 Operations." Proc. 6th Intl. Coll. Paratuberculosis: Manning EJB, = Collins=20 MT(eds) 1999.

[370]=20 Merkal RS and DL Whipple. "Inactivation of Mycobacterium bovis in Meat=20 products." Applied and Environmental Microbiology 40(1980):282-4. =

[371]=20 Paratuberculosis Awareness Research Association. "Mycobacterium = paratuberculosis=20 in retail beef supplies." http://members.aol.com/ParaTBweb/beef.htm

[372]=20 Merkal RS, JA Crawford and DL Whipple. "Heat Inactivation of = Mycobacterium=20 avium-Mycobacterium intracellulare Complex Organisms in Meat Products."=20 Applied and Environmental Microbiology 38(1979):831-5.

[373]=20 Riemann HP and B Abbas. "Diagnosis and Control of Bovine = Paratuberculosis=20 (Johne's Disease)." Advances in Veterinary Science and Comparative=20 Medicine 27(1983):481-505.

[374]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[375]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:51.

[376]=20 Hermon-Taylor, J, et al. "Mycobacteria and the Aetiology of Crohn's = Disease."=20 Inflammatory Bowel Disease 1994. http://iol.ie/alank/CROHNS/paratub.htm. =

[377]=20 Paratuberculosis Awareness & Research Association. "MAP in food: The = case=20 for retail testing." Presented to the Food Safety Committee of the = United States=20 Animal Health Association in October 1998.=20 http://www.crohns.org/foodsafety/retail.htm.

[378]=20 Riemann HP and B Abbas. "Diagnosis and Control of Bovine = Paratuberculosis=20 (Johne's Disease)." Advances in Veterinary Science and Comparative=20 Medicine 27(1983):481-505.

[379]=20 Institute for Food Science and technology. "Mycobacterium = paratuberculosis and=20 Milk." Food Science and Technology Today 12(1998):223-7.

[380]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[381]=20 Sartor, RB. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:366-373.

[382]=20 "UK scientists link Crohn's to superbug in cow's milk." Canadian = Business and=20 Current Affairs v.32(22) June 11, 1996:52.

[383]=20 Brown ST, et al. "Mycobacterium paratuberculosis in Crohn's Disease."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:316-23.

[384]=20 Lord Burlison. "Crohn's Disease." Debate in the House of Lords. 19 Jun = 2000.=20 Column 82.

[385]=20 Sartor, RB. "M paratuberculosis in Foods and the Public Health = Implications."=20 Proceedings of the Fifth International Colloquium on = Paratuberculosis=20 Chiodini RK, Hines ME, and MT Collins (Eds.) Madison, WI: International=20 Association for Paratuberculosis, 1996:366-373.

[386]=20 Naser, SA and I Shafran. "Isolation of Mycobacterium avium subsp=20 paratuberculosis from Breast Milk of Crohn's Disease Patients." = American=20 Journal of Gastroenterology 95(2000):)1094-5.

[387]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:49.

[388]=20 Hulten K. "Antibacterial Therapy for Crohn's Disease: A Review = Emphasizing=20 Therapy Directed Against Mycobacteria." Digestive Diseases and = Sciences=20 45(2000):445-56.

[389]=20 "Statement in Relation to UK MAFF Announcement." Food Safety Authority = of=20 Ireland Press Release. 11 August 1998.

[390]=20 "Ireland Bans Milk, Meat from Cows Infected with Suspected Crohn's Bug." = Paratuberculosis Awareness and Research Association News Release. 6 = October=20 2000.

[391]=20 21,500 to be more exact, dividing the US prevalence per (USDA: APHIS. = "Johne's=20 Disease on U.S. Dairy Operations." National Animal Health Monitoring = System.=20 October, 1997.) by the Irish prevalence per ("Statement in Relation to = UK MAFF=20 Announcement." Food Safety Authority of Ireland Press Release. 11 August = 1998.)=20

[392]=20 Paratuberculosis Awareness & Research Association. "MAP in the = United=20 Kingdom." http://www.crohns.org/government/uk.htm, 1999.

[393]=20 "Western Dairy Producers Introduce Johne's Disease Control Proposal but = Crucial=20 Human Health Issues Missing from Plan." Paratuberculosis Awareness and = Research=20 Association Press Release. 30 October 2000.

[394]=20 Nauta MJ and JWB van der Giessen. "Human Exposure to Mycobacterium=20 paratuberculosis via Pasteurized Milk: A Modeling Approach." = Veterinary=20 Record 12 September 1998:293-6.

[395]=20 Hulten K. "Antibacterial Therapy for Crohn's Disease: A Review = Emphasizing=20 Therapy Directed Against Mycobacteria." Digestive Diseases and = Sciences=20 45(2000):445-56.

[396]=20 Paratuberculosis Awareness and Research Association. "PARA Takes the = Case for=20 Retail Testing to USAHA(U.S. Animal Health Association)."=20 http://www.crohns.org/media/pr151098.htm

[397]=20 Lord Greenway. "Crohn's Disease." Debate in the House of Lords. 19 Jun = 2000.=20 Column 82.

[398]=20 Chamberlain, L. "Lactose Intolerant." Cleveland Free Times June, = 1999.=20

[399]=20 "Crohn's link with bacteria in milk." Chemist & Druggist = January 29,=20 2000:11.

[400]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:4.

[401]=20 Stuttaford, T. "Lack of Proof Led to Disaster." The Times 26 = October=20 2000:4.

[402]=20 Foster KR, Vecchia P and MH Repacholi. "Science and the Precautionary = Principle"=20 Science 12 May 2000:979-81.

[403]=20 Wingspread Statement on the Precautionary Principle. January = 23-25 at=20 Wingspread in Racine, Wisconsin, 1998.

[404]=20 "Crohn's and Milk Blamed on Rabbits." The Herald (Glasgow)12 = August=20 1998:4.

[405]=20 Kennedy, A. "Why IBD sufferers should only consume UHT or Ultra = Pasteurized=20 dairy products." http://www.iol.ie/alank/CROHNS/uhtmilk.htm

[406]=20 Collins JD et al. Mycobacterium paratuberculosis: Does it contribute = to=20 Crohn's Disease? Dublin: Food Safety Authority of Ireland, 2000. =

[407]=20 "January 2000 FSAI report: Mycobacterium paratuberculosis -- Does it = contribute=20 to Crohn's Disease?" Paratuberculosis Awareness and Research = Association.=20 http://www.crohns.org/media/pr290900.htm

[408]=20 Kennedy, A. "Biopsy studies of Crohn's Disease."=20 http://www.iol.ie/alank/CROHNS/biopsy.htm

[409]=20 Collins JD et al. Mycobacterium paratuberculosis: Does it contribute to = Crohn's=20 Disease? Dublin: Food Safety Authority of Ireland, 2000.

[410]=20 Mohr, P. "Yanking Johne's chain: With management, testing and = vaccinating, the=20 Steins plan to get this Disease under control." Dairy Today = November=20 1997.

[411]=20 Patterson CJ, et al. "Accidental Self-inoculation with Mycobacterium=20 paratuberculosis bacterin (Johne's bacterin) by veterinarians in = Wisconsin."=20 Journal of the American Veterinary Medical Association = 192(1988):1197-9.=20

[412]=20 Chiodini RJ. "Crohn's Disease and the Mycobacterioses." Clinical=20 Microbiological Reviews 2(1989):90-117.

[413]=20 NAID. "Crohn's Disease - Is There a Microbial Etiology? Recommendations = for a=20 Research Agenda." Conference was held in the Natcher Conference Center = on the=20 NIH campus in Bethesda, Maryland on December 14th, 1998.

[414]=20 Thompson DE. "The Role of Mycobacteria in Crohn's Disease." Journal = of=20 Medical Microbiology 41(1994):74-94.

[415]=20 Weiss R. "What's the Matter with Milk?" Health (ISSN: 1059-938X) = 7(1993):18

[416]=20 Murray, I. "Crohn's Linked To Bacteria In Milk." The Times = (London)=20 January 25, 2000:Home News.

[417]=20 Adamson C and P McGowan. "Blame Placed on Intensive Farming." The = Times=20 26 October 2000:10-1.

[418]=20 Brower M and W Leon. The Consumer's Guide to Effective Environmental = Choices:=20 Practical Advice from the Union of Concerned Scientists. Three = Rivers Press,=20 1999

[419]=20 Daily GC and PR Ehrlich. "Development, Global Change, and the = Epidemiological=20 Environment." Paper #0062. Center for Conservation Biology. Stanford = University.=20 Stanford, California, 1995.

[420]=20 Kipple, K. F. (ed) (1993), The Cambridge World History of Human = Disease,=20 Cambridge University Press, Cambridge.

[421]=20 Maugh, TH. "Milk May be the Carrier of Crohn's." Los Angeles = Times 18=20 September 2000:S1.

[422]=20 Gutknecht, K. "A needling question: Does Pasteurization really kill M.=20 paratuberculosis?" Wisconsin Agriculturist July 1998

[423]=20 Scientific Committee on Animal Health and Animal Welfare. Possible = links=20 between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000 = European=20 Commission Directorate-General Health & Consumer Protection = Directorate B -=20 Scientific Health Opinions Unit B3. Adopted 21 March 2000:4.

[424]=20 Gutknecht, K. "Dire Warnings About Johne's Disease: A wake-up call for = the dairy=20 industry?" Wisconsin Agriculturist. December 1998.

[425]=20 "Project Censored." Paratuberculosis Awareness and Research = Association=20 Newsletter. July, 2000:2.