Public Health Implications and Consumer Recommendations

Kathi S. Allen
S.T.O.P.-Safe Tables Our Priority
USDA/FSIS Premature Browning of Cooked Hamburger Study Public Meeting
Arlington, VA
May 27, 2025

Thank you for inviting me to present consumer recommendations on food-safety messages. First, however, I'd like to tell you what motivates a busy mother of four and a business owner to give up family and work time to promote changes in our food safety messages. I wouldn't have volunteered for this but some things change your life.

For me, that change happened in January 1993. Up until that time I was like most American consumers-the only food safety training I had was a two-minute speech in an eighth grade home economics class. Then, I went to visit my children's classmate who was seriously ill in children's hospital. Horrific lessons in food safety were permanently imprinted on my mind from that trip to pediatric intensive care during the Jack In the Box outbreak. I wasn't prepared for what I saw:

• 60 families huddled on plastic mats on the floor waiting for news on their children's health.
• A grandmother having a heart attack on the floor. She was refusing paramedics pleas to transport to another hospital. She wouldn't leave her critically ill grandchild at Children's.
• A doctor telling a family "I'm sorry but we have to take your [two- year- old] son's colon out."
• Then, the helicopter blades overhead and the audible gasp that signaled the arrival of another critically ill child.
• The desperate search for enough dialysis machines for pediatric intensive care patients.

And then, I saw Brianne. These pictures only tell a small portion of the damage these pathogens can inflict on the human body. Don't let anyone deceive you into believing that food borne illness is similar to gas pains or a mild upset stomach. My nephew's "mild" battle with E.Coli 0157:H7 will perhaps let you see inside a mild case. He was a 21-year-old "macho" male when he ate a "brown" but undercooked contaminated hamburger. When I visited him he was rolling in his bed crying and bleeding rectally. He said, "It feels like my insides are being boiled in oil." That's mild.

But back to Brianne. I left the hospital wondering, "How could a hamburger do this, how can I and my family be safe? I resolved to find answers. Brianne's illness was caused by contaminated meat and a restaurant's failure to cook hamburgers to the state required temperature. It was not a failure to cook until brown. Her case brought the largest settlement in Washington State history-over $15 million dollars and it is questionable whether it will be enough to cover her life long medical needs.

But here is the question some in this room need to consider. Who's responsible when consumers become critically ill from following flawed messages delivered by credible public health representatives?

In the wake of the Jack in the Box outbreak, the "brown in the middle" message blared from every TV and newspaper in this country. Even though the problem with premature browning had already been noted, consumers were not warned.

Let me tell you some stories of consumers reliance on the brown in the middle messages. Six months after Jack in the Box, Nancy Donley served her son Alex a brown hamburger. What happened to Alex from eating brown hamburger? I'll read portions from her statement at last year's National Food Safety Educator's Conference, "Alex's screams were followed by silence he suffered tremors and delusions monitors registered organ failure after organ failureportions of his brain were liquefiedmy only child, my long awaited, much-loved six year old son was dead."

"I can't tell you the number of times I've been asked by well-meaning people, "Didn't you cook it?" Of course I cooked it! I did what millions of people do all the time. I fired up the Smokey Joe, put the pre-formed patties on the grill, and when they looked cooked, fed them to my family."

A year after the outbreak, Holly Scott fed her son a hamburger. She too believed brown meant a safer burger. Holly's son died an believably painful death. This three year-old's pain was so intense that he broke his teeth from biting down. Holly buried her only child on the one-year anniversary of the outbreak. Damion Heersink ate one bite of brown hamburger on a Boy Scout campout, he spent six weeks in intensive care and required 100 units of blood. I tell you these stories not, as some may accuse, to tug at your emotions, but to let you know very clearly what science has already told you, using hamburger color as an indicator of doneness is a fatally flawed message. And I tell you these stories to answer a recent meat industry representative's comment to me, "Show me the bodies."

What Consumers Need

What consumers need and expect from those charged with our safety is encapsulated in one word-truth. Every family of an ill child who contacts S.T.O.P. says "I wish I'd known. Why wasn't I told?." Would Nancy and Holly have used a thermometer if they had known the risk? Absolutely. But, they weren't told.

So, what is the scientific evidence saying?

• Reaching an internal temperature of 160°F is the only effective method of destroying pathogens in a hamburger.
• A certain percentage of ground beef will look fully cooked before it has reached a safe internal temperature.
• A certain percentage of ground beef will have persistent pinkness regardless of internal temperature.
• A percentage of consumers who trust the color message will unknowingly put themselves at risk by eating brown undercooked ground beef.

Why the resistance to telling the truth? I've been told:

1. We don't want to associate risk with eating a hamburger.
2. Consumers are not likely to use a thermometer.
3. The correct message isn't simple enough.
4. Accurate thermometers aren't available.
5. It won't taste as good.

The truth is the truth, whether or not industry likes it or established education campaigns are working. The evidence is clear. What consumers do with the information is their choice. But, they must be given the chance to make an educated choice and not placated with false and dangerous messages.

Currently, at least three states are experiencing clusters or outbreaks. A question for those in this room who favor color messages: Did you contribute to these illnesses by advocating the dangerous message of trusting color? Did you weaken the temperature message by using something like these consumer messages?

• GA Department of Health-"Cook all ground beef and hamburger thoroughly. Make Sure the cooked meat is brown throughout (not pink) and juices run clear. ( Note: no temperature warning.)
• Texas A&M-The public may be unsure about using thermometers." "We still recommend that consumers cook meats thoroughly until they are brown, particularly hamburger." "For the vast majority of cases, brown meat is safe meat."
• Allegheny Health Department-"If using a meat thermometer is not possible to check the temperature of a hamburger, follow the advice of the Health Department's most popular mascot Browny the Burger, who says, "If I'm pink in the middle, I'm cooked too little."

Seven billion pounds of ground beef are consumed in the US each year. Given that a certain percentage will turn prematurely brown, some of the consumers who follow your "brown" advice are at risk. Kansas State University tested retail ground beef and found an average of 46% premature browning BEFORE reaching a safe temperature. The FSIS/ARS study found nearly two thirds of previously frozen hamburger turned prematurely brown before reaching a safe internal temperature. No matter which percentage you choose, any percentage of seven billion is too much risk for uninformed consumers.

What we want you to know about the consumer

1. Today's typical consumer has very little food safety instruction. Most of us just received the two-minute cooking class lecture in junior high and today's sound bites. We expect those who are responsible for crafting today's sound bites to give us safe and reliable messages.
2. Consumers do not use thermometers because they don't understand the need. Why should they use thermometers when you've crafted an easier (although less safe) alternative? Continuing to spread the message that "Brown in the middle is safe" endangers consumers and weakens the temperature messages. Consumer safety messages must be based on science rather than what you believe will be more acceptable.

In conclusion, I ask you, on behalf of all consumers, to take your responsibility to the American consumer very seriously. Inform the public today that temperature is the only reliable indicator of hamburger doneness. Correct your websites, brochures, press releases and educational materials. Change your PSA's. Present a unified temperature only message. Yes, it is a big job to re-educate the American Public. But, given your success in dispersing your well-intentioned but dangerous brown message, we have no doubt you can succeed.

What do consumers want from those entrusted with crafting public health and safety messages-the truth.

Color and Cooking References

Meat and Poultry Magazine. March 1989. "USDA's Hamburger Alert"

Trout, G.R. 1989. "Effect of pH and Total Pigment Concentration on the Internal Color of Cooked Ground Beef Patties." J.Food Sci. 54(1):1-2.

Food Chemical News. January 30, 1989. P. 23-24, 60-64.

Marksberry, C.L. 1990. "The Effect of Fat Level. PH, Carcass Maturity and Compaction on the Cooked Internal Color of Ground Beef Patties at Five End-Point Temperatures."

Cornforth, D., Calkins, C.R., Faustman, C. 1991. "Methods for Indentification and Prevention of Pink Color in Cooked Meat." Reciprocal Meat Conference Proceedings, AMSA 44:53-58.

Thurston County Health Department (WA), September 1992. Article titled, "I'll take my E.Coli Well Done, Please!" "You can't tell the temperature just by looking at the food".Ground beef must now be cooked to 155F."

USDA. 1992. Meat and Poultry Inspection. Report of Secretary of Agriculture to U.S. Congress. USDA. Washington, DC.

FDA. 1993. Food Code. US Public Health Service, Food and Drug Administration. Washington, D.C.

Warren, K.E. 1994. "An investigation of the chemical properties associated with normal and premature brown cooked color development in ground beef patties." Ph.D. Dissertation. Kansas State University, Manhattan, Kansas

Berry, B.W. 1994. "Fat Level, High Temperature Cooking and Degree of Doneness Affect Sensory Chemical and Physical Properties of Beef Patties." J. Food Protection. 59 (1): 10-14,19.

Hague, M.A., Warren, K.E., Hunt, M.C., Kropf, D.H., Kastner, C.L., Stroda, S.L., and Johnson, D.E. 1994. "Endpoint temperature, internal Cooked Color, and Expressible Juice Color Relationships in Ground Beef Patties." J. Food Science. 59 (3):465-470.

Warren, K.E., Hunt, M.C., and Kropf, D.H. 1995a. "Myoglobin oxidative state affects internal cooked color development in ground beef patties." International Congress Meat Sci. and Technology. 41: 394-395.

Warren, K.E., Hunt, M.C., Kropf, D.H., Hague, M.A., Waldner, C.L., Stroda, S.L. and Kastner, C.L. 1995b. "Chemical properties of ground beef patties exhibiting normal and premature brown internal cooked color." Journal Muscle Foods.

Warren, K.E., Hunt, M.C., Kropf, D.H., Hague, M.A., Waldner, C.L., Stroda, S.L. and Kastner, C.L. 1995. Department of Animal Sciences, Kansas State University, Manhattan, Kansas. Presentation to American Chemical Society. April 6, 1995.

FSIS-Technical Information, June 1996. "Color of Cooked Ground Beef and Juices as it Relates to Doneness. "Recent research results have raised questions regarding suggestions for the visual checks for doneness." ground beef may appear to have lost all pink color before it is fully cooked." It may look fully cooked before it reaches a safe internal temperature." Persistent pinkness-"There are several reasons why ground beef may remain pink at temperatures above 160F." Under advice for consumers on avoiding foodborne illness, "Thorough cooking is most accurately measured by use of a meat thermometer."

USDA/FSIS-Technical Information. February 1997. "Addendum to Color of Cooked Ground Beef and Juices as it Relates to Doneness" Technical Information from FSIS, April 1996.

Clinton, Hillary. "Food-Safety Regulations Help to Ensure 4th Remains Festive." The Washington Times. Page A2. July 3, 1997.

Correspondence. May 1998. Dr. Hunt. Retail ground beef percentages of Premature Browning.

FSIS/ARS Study: Premature Browning of Cooked Hamburgers. Draft. May 1998.