The CDC estimates that foodborne pathogens cause 76 million cases of gastrointestinal illness every year. 325,000 of these illnesses require hospitalization, and about 5,000 people die annually. (See Paul S. Mead, et al., Food-Related Illness and Death in the United States, 5 Emerging Infect. Dis. (No. 5) 607, 614 (1999)). It is estimated that the five most common foodborne pathogens alone cause a loss of $6.9 billion annually in medical expenditures, productivity losses, and the costs of premature death. (See Crutchfield, S.R. and T. Roberts, “Food Safety Efforts Accelerate in the 1990s,” FOOD REVIEW, 23,3:44-49,(2000)) But what these staggering statistics don’t account for are the personal economic costs and physical losses that some victims of foodborne disease (i.e., the permanently injured) face in the future. These losses can be astronomical, both economically and personally.
In those cases of severe foodborne disease that don’t end in death, likely the most costly condition that we regularly see is hemolytic uremic syndrome (HUS). Post-diarrheal Hemolytic Uremic Syndrome (D+HUS) is a severe, life-threatening complication that occurs in about 10% of those infected with E. coli O157:H7 or other Shiga toxin (Stx) producing E. coli. It is now recognized as the most common cause of acute kidney failure in infants and young children.
In a significant subset of HUS victims, the spectrum of long-term kidney complications runs from fairly benign conditions to end stage renal disease (ESRD), an inexorable process by which the kidneys lose their filtering capacity until the patient requires dialysis or kidney transplantation to survive. Many such victims will suffer from myriad physical complications before, during, and after kidney transplantation, including: (1) alterations in calcium and phosphate balance, known as renal osteodystrophy, that cause the bones to become weak and soft, resulting in bone pain and susceptibility to fracture; (2) anemia —which is characterized by a low red blood cell count and consequent lack of energy; (3) growth failure caused by the damaged kidney’s inability to properly regulate the calcium necessary for bone growth; and (4) high blood pressure, which, among other things, stresses the heart and can lead to coronary artery disease, heart attack, and stroke.
Following transplantation, the victim will require immunosuppressive medications for the rest of her life to prevent rejection of the transplanted kidney. Medications used to prevent rejection have considerable side effects. Corticosteroids are commonly used following transplantation. The side effects of corticosteroids are Cushingnoid features (fat deposition around the cheeks and abdomen and back), weight gain, emotional instability, cataracts, decreased growth, osteomalacia and osteonecrosis (softening of the bones and bone pain), hypertension, acne, and difficulty in controlling glucose levels. The steroid side effects, particularly the effects on appearance, are difficult for children, particularly teenagers, and non-compliance with the treatment regimen is a problem with teenagers due to unsightly side effects.
Clearly, the physical impediments to leading a normal life for victims of severe HUS are many. The economic losses that frequently result in such cases are correspondingly staggering. We have represented many people, mostly children, in these unfortunate circumstances. A brief review of three such cases selected at random reveals an average cost of $5,776,352 for medical care and future income losses.