NR AAUP
AU Ashraf,H.
TI BSE inquiry uncovers "a peculiarly British disaster"
QU Lancet 2000 Nov 4; 356(9241): 1579-80
IA http://www.thelancet.com/journal/vol356/iss9241/news
PT news, Editorial
VT
The report of the public inquiry into the handling of the bovine spongiform encephalopathy (BSE) crisis (www.bse.org.uk), which resulted in the slaughter of 177 390 cattle on 35 103 farms, the death of 85 people, and all but wiped out the UK beef industry, has found that the previous government was complacent and concealed the damaging effects of BSE from the public. The 16 volumes of findings of the inquiry, chaired by Lord Phillips, the second most senior judge in England and Wales, did not blame politicians, contrary to intense media speculation, and instead stated that most people involved emerged with credit.
After Phillips's statement to the assembled media, the Secretary of State for Health, Alan Milburn, announced that a care fund would be set up for patients with the human form of BSE - known as variant Creutzfeldt-Jakob disease (vCJD) - and their families, and promised faster diagnosis of the fatal neurological disease, better quality care for patients, and a national network of experts to help clinicians manage vCJD patients. The Minister for Agriculture, Nick Brown, added that patients and their families would receive compensation for "this dreadful disease".
Phillips stated that "any who have come to our report hoping to find villains and scapegoats, should go away disappointed". But specific criticisms were levelled against the Ministry of Agriculture, Fisheries, and Food (MAFF), the Department of Health (DoH), and the government's special advisors: the Chief Veterinary Officer (CVO), Keith Meldrum, the successive Chief Medical Officers (CMO), Donald Acheson and Kenneth Calman, and the government's scientific advisory committees (see Editorial).
The report states that the origins of BSE may never be known. But the catastrophic events of the past 15 years occurred because rendered BSE-infected cattle offal, including brain and spinal cord, was used to produce meat and bone meal (MBM) for cattle feed. The recycling and wide distribution of infected MBM wreaked havoc in UK cattle herds and allowed infected beef to enter the human food chain and manifest itself as vCJD.
MBM has been used in intensive farming since 1926. Critics had argued that BSE was caused by relaxing the standards for production of MBM. However, the report suggests that changes to the rendering process would not have prevented the BSE crisis.
Although scientists believe BSE may have first appeared in the 1970s, the report begins in 1986 when neuropathologist, Gerald Wells and colleagues at the Central Veterinary Laboratory (CVL) identified a spongiform encephalopathy in cattle, which they concluded was probably caused by scrapie-infected MBM that had been fed to cattle. Scrapie is a transmissible spongiform encephalopathy and has been enzootic in sheep for more than 200 years. In 1986 scientists were not too concerned because scrapie-infected sheep had been allowed to enter the human food chain with no damaging effects.
In 1987 more infected cattle were identified and John Wilesmith, head of CVL's epidemiology department, was asked to investigate. The report notes that during the first half of 1987 the State Veterinary Service and MAFF implemented a policy of restricting dissemination of information about BSE that should not have happened.
In December, 1987, Wilesmith said that the outbreak originated from offal of scrapie-infected sheep rendered to make MBM. The outbreak was spread by MBM used in cattle feed, and relaxing the standards of the rendering process, which actually coincided with the outbreak, allowed the BSE agent to survive the rendering process, he concluded. Wilesmith recommended a temporary ban on MBM while further investigations were done.
The report commends Wilesmith's decision to request a ban but notes his theory of the scrapie origins of the disease was wrong. The report states that BSE probably originated in the 1970s from a novel source, such as one cow that developed the disease after a gene mutation.
MAFF always knew that BSE might have implications for human health. By the end of 1987 MAFF's concerns prompted them to consider whether animals showing signs of BSE, once slaughtered, should be used for human consumption. MAFF did not share these fears with DoH, which the report says was a mistake.
But MAFF waited until March, 1988, when it had decided that BSE-infected animals should be destroyed and compensation paid to farmers, before consulting the CMO, Donald Acheson. Acheson's decision to set up the Southwood Working Party, chaired by Prof Richard Southwood, from Oxford University, was of "crucial importance in safeguarding human health", says the report.
The Southwood report, submitted in February, 1989, endorsed Wilesmith's theory of the origins of BSE, and concluded that it was "most unlikely that BSE would have any implications for human health". This was to remain the government's official stance until 1996.
However, some scientists were having their doubts. Prof Roy Anderson, an epidemiologist now working at the Wellcome Trust, made repeated requests in 1989-90 for access to BSE data held at CVL. MAFF turned those requests, says Anderson, they said "they did not need any external scientific input into the BSE database analysis". If data had been available scientists could have calculated "what were the best culling options to reduce the size of the epidemic quickly", says Anderson.
Phillips's report criticises some aspects of the Southwood report "but those criticisms should not obscure the vital benefit that the working party provided in putting an immediate stop to the practice of eating BSE-diseased animals". However, the report notes that Southwood admitted in August, 1988, that "if our assessment of these likelihoods is incorrect, the implications would be extremely serious". Another glaring error, says Phillips, was that "the Southwood report was cited as if it demonstrated as a matter of scientific certainty rather than provisional opinion, that any risk to humans from BSE was remote".
In November, 1989, ministers were still concerned about the strength of the Southwood report's measures and decided to ban the use of specified bovine offal (SBO) - the human SBO ban. By now the UK meat industry's predicament was gathering interest around the world. In July, 1989, the European Union (EU) put in place the first of many restrictions on UK beef exports. By the end of 1989 there were 10 091 BSE cases. This was followed in March, 1990, by another EU ruling that restricted UK beef exports to live cattle less than 6 months old.
About a month later, the government set up a new scientific advisory committee, the Spongiform Encephalopathy Advisory Committee (SEAC), to advise MAFF and DoH. In May, 1990, the CJD surveillance unit was established, in line with a recommendation by the Southwood report that surveillance of CJD cases should be increased. Later that month the first known case of feline spongiform encephalopathy (FSE) in a cat prompted media speculation that BSE might infect humans. SEAC considered the "risk of transmissibility to humans as remote only because precautionary measures had been put in place".
Iain Mcgill, a neuropathologist who worked at CVL from 1990 to 1991, says that "there was a culture of suppressing information and scientists not being allowed to carry out or publish the research they needed to. In 1991 Gerald Wells and I were refused permission to publish the indication that there might be a causal link between BSE and FSE. Phillips states that the discovery of FSE was "a bombshell" and "had raised a concern that BSE might be transmissible in a way that scrapie was not".
Public doubt was now spreading, and in an attempt to maintain confidence in the beef industry the agriculture minister, John Gummer, famously tried to feed a beefburger to his daughter on a televised outing. In July, 1990, a House of Commons Agriculture Committee reported that the measures taken by the government "should reassure people that eating beef is safe".
The government's reassurance plainly misled the general public. Although the public was told that BSE might not behave like scrapie, the public was not told that BSE might be transmissible to human beings, says the report
Some of the BSE Inquiry's conclusions
* BSE developed into an epidemic because of intensive farming
* The government took sensible measures but they were not timely or adequately enforced
* The government believed the risks of BSE to humans were remote
* The possibility of the risk to humans was not communicated to the public
* Expert committees are a valuable resource but advice sought must be carefully targeted and reviewed
As the number of BSE cases increased, it seemed that confidence in government policy decreased. The pet-food industry questioned whether it should still use SBO in pet food when this was banned for human beings. MAFF eventually relented and imposed the animal SBO ban. By the end of 1990 there were 24 396 cases of BSE.
The government now believed that with compulsory slaughter policies, the ban on potentially infective bovine tissue from the human and animal food chains, and policies to prevent bovine tissue from being used in medicinal and cosmetic products, the public and the meat industry were adequately protected. But there were still more cases than government epidemiologists expected.
The report notes that the government had made a crucial error by allowing the animal feed trade a period of grace to clear their stocks of ruminant feed. "Some members of the feed trade . . . continued to clear stocks after the ban came into force." This meant that although the government had banned ruminant feed, thousands of animals were still being infected.
Another reason for the "born after the ban" BSE cases was that CVL found that non-ruminant feed was being contaminated by ruminant feed in manufacturing plants - studies noted that 1g of BSE infective tissue was enough to infect a cow. In April, 1995, MAFF responded by transferring regulation of slaughterhouses from local authorities to the newly formed Meat Hygiene Service; and introduced strict field monitoring and enforcement of the BSE policies.
The report notes that to the government's credit the original ruminant feed ban had caused the number of BSE cases to steadily decrease. The stringent measures taken in 1994 and 1995 simply accelerated this decrease.
IN Der Autor meint, der 16 Bände starke Abschlußbericht des BSE Inquiry führe die britische BSE-Katastrophe mit 177390 registrierten BSE-Fällen auf 35103 Farmen letztlich auf die bereits seit 1926 in der intensiven Tierhaltung eingesetzten Verfütterung von Tiermehlen zurück. Der Bericht halte aber dem britischen Landwirtshaftsministerium, dem britischen Gesundheitsministerium, den die Regierung wissenschaftlich beratendenden Komitees, sowie den speziellen Beratern der britischen Regierung Keith Meldrum (Chief Veterinary Officer), sowie Donald Acheson und Kenneth Calman (Chief Medical Officers) vor, das Ausmaß der Schäden durch fehlerhaftes Verhalten verschlimmert zu haben. Die allgemeine Laxheit im Umgang mit der neuen Krankheit BSE wird damit erklärt, dass man BSE für eine Scrapie-Variante hielt und weil scrapie scheinbar seit Jahrhunderten seine Ungefährlichkeit für Menschen bewiesen habe. Der BSE Inquiry Abschlußbericht erklärt die Hypothese von scrapie als Quelle für die Entstehung von BSE für falsch (und überschreitet damit eindeutig seine wissenschaftlich dürftigen Kompetenzen). Falsch sei aber auch die restriktive Informationspolitik gewesen. Es wird auch kritisiert, dass das Landwirtshaftsministerium die Bedenken des Gesundheitsministeriums hinsichtlich der Verwendung BSE-kranker Tiere in menschlicher Nahrung nicht geteilt habe. Erst ab März 1988 mußten BSE-Tiere vernichtet werden und die Bauern wurden entschädigt. Besonders schlimm habe sich die schlecht begründete Einschätzung des Southwood-Reports im August 1988 ausgewirkt, BSE berge sehr wahrscheinlich keine Gefahren für Menschen. Diese Einschätzung bestimmte die Haltung der britischen Regierung bis 1996, obwohl der Southwood-Report vor extremen Gefahren für den Fall gewarnt hatte, dass seine vorläufige Einschätzung sich als falsch erweisen sollte. Vielleicht erklärt dies die Arroganz des britischen Landwirtshaftsministeriums, welches die Herausgabe der 1989-1990 wiederholt vom Epidemiologen Prof Roy Anderson angeforderten BSE-Daten durch das Central Veterinary Laboratory mit der Begründung ablehnte, man benötige keine externe Unterstützung bei der Analyse der Daten. Im Juli 1989 führte die Europäische Union die ersten Exportbeschränkungen für Produkte der britischen Rinderhalter ein. Erst im November 1989 wurde in England die Verwendung der als im Falle einer unerkannten BSE-Infektion besonders gefährlich erachteten Gewebe (SBO) in menschlicher Nahrung verboten. Aber Ende 1989 gab es bereits 10091 bekannte BSE-Fälle. Seit März 1990 durften daher nur noch britische Kälber exportiert werden, die weniger als 6 Monate alt waren. Etwa einen Monat danach setzte die britische Regierung ein neues wissenschaftliches Komitee (SEAC) zur Beratung der Regierung zu Fragen im Zusammenhang mit übertragbaren spongiformen Enzephalopathien ein. Im Mai 1990 wurde die britische Arbeitsgruppe zur Überwachung der Creutzfeldt-Jakob-Krankheit eingerichtet. Auch bereits im Mai 1990 machte ein Fall von spongiformer Enzephalopathie bei einer Katze auf eine mögliche Übertragbarkeit von BSE auch auf den Menschen aufmerksam. Das SEAC reagierte darauf jedoch nur mit Abwiegelung und Iain Mcgill und Gerald Wells wurden 1991 daran gehindert, einen Artikel über ihre Hinweise auf einen Zusammenhang zwischen BSE und der ganz ähnlichen Katzenkrankheit zu veröffentlichen. Es entstand ein Klima der Unterdrückung alarmierender Informationen, während die Regierung unter anderem mit der spektakulären Aktion des Landwirtschaftsministers John Gummer unter Mißbrauch seiner kleinen Tochter alles versuchte, den Fleischkonsum der Briten zu steigern. Mit zunehmenden Fallzahlen nahm in der Industrie das Vertrauen in die Maßnahmen der Regierung ab und beispielsweise fragten die Heimtierfutterhersteller, wieso denn die Heimtiere noch fressen sollten, was für Menschen zu gefährlich sei. Die Regierung reagierte und verbot die Verwendung von SBO auch für Tiere (allerdings mit Ausnahmen). Aber Ende 1990 gab es auch schon 24.396 BSE-Fälle. Die Regierung aber glaubte, die Industrie und die Bevölkerung durch ein selektives Schlachtprogramm, die Vernichtung der SBO und halbherzige Aktionen gegen die Verwendung von Rinderprodukten in medizinischen und kosmetischen Produkten ausreichend zu schützen. Dabei lagen die BSE-Fallzahlen ständig über den Schätzungen der von der Regierung bezahlten Epidemiologen. Der Report kritisiert als einen Fehler der Regierung, dass man dem Handel erlaubte, die noch in den Lägern befindlichen verbotenen Waren zu verkaufen. So wurden tausende Rinder noch nach Einführung des Verfütterungsverbotes infiziert und allen Beteiligten wurde eine geringe Dringlichkeit der Maßnahmen suggeriert. Ein anderer Grund für die Infektion von Rindern noch nach dem offiziellen Tiermehlverfütterungsverbot war die Kreuzkontamination bei Futtermittelherstellern (Handel und Landwirte hätte man auch nennen können). Obwohl Studien eine für Rinder tödliche Dosis von nur 1 Gramm Rinderhirn ermittelten, übertrug das MAFF erst im April 1995 als Reaktion auf diese Mißstände die Kontrolle der Schlachthöfe von den lokalen Behörden auf den neu gegründeten Meat Hygiene Service. Erst von da an wurden die seit 1988 eingeführten Maßnahmen wirklich kontrolliert umgesetzt.
MH Animal; Cattle; Creutzfeldt-Jakob Syndrome/mortality/*transmission; Disease Outbreaks/*veterinary; Encephalopathy, Bovine Spongiform/*epidemiology; Great Britain/epidemiology; Human
SP englisch
PO England