Risk and Reward: An Interview with the Pew Health Group's Shelley Hearne

Spring 2010 Trust Magazine article

In September, at an event in Iowa focused on food safety oversight, U.S. Senator Tom Harkin hailed Pew as “a true national treasure” and “a major source of light—and enlightenment.” That sentiment reached the core of the Pew Health Group’s commitment to improving public policy and informing the public by conducting rigorous analysis and developing fact-based solutions.

Trust asked managing director Shelley Hearne to describe the strategy behind her multifaceted program, which ranges from enhancing food safety oversight and eliminating medical conflicts of interest to reform of credit-card industry practices.

Trust: The Pew Health Group defines “health” in such a comprehensive way. There must be so many different issues that fall within your purview.

Hearne: There are, but we narrow things down by focusing on how to limit unnecessary health risks in the products that consumers use every day—from food to financial services.

Trust: There are products that people use every day that pose obvious risks—like cigarettes—but what are the unnecessary risks that you are focusing on?

Hearne: We take the same approach with all of our projects: identify preventable hazards and create a system of accountability to minimize those risks.

Take, for example, our Pew Prescription Project, which is bringing more transparency to help the public and policy makers follow the financial relationships between pharmaceutical companies and health care providers. When I go to a doctor’s office, I want to trust that I get what’s best to make me healthier.

Credit-card industry practices pose risks to health as well. Data show that your economic well-being will influence how long you and your children live as well as the quality of your life as you reach your retirement years.

It’s fairly simple: Hidden fees and predatory practices by credit card companies can be detrimental to a family’s economic well-being and, in turn, greatly impact health. The Safe Credit Cards Project, which was initially a one-year undertaking with the Sandler Foundation, has addressed the growing concerns about the credit card industry and how to ensure a safe and fair product for everyone.

Trust: What else is the Pew Health Group working on?

Hearne: One is food safety. Millions of people get sick every year due to food-related illness, but until it’s your child, it can be difficult to focus in on the realities and implications of what E. coli or other deadly pathogens mean to everyday Americans.

Trust: Maybe I shouldn’t admit this, but when I’m at the grocery store, I’m not typically thinking about deadly pathogens. Should I be?

Hearne: If we do our job right, you shouldn’t have to worry when you go to the market. You should have confidence that the peanut butter you’re picking off the shelf is not going to have some unknown pathogen lurking in it that could cause grave sickness. That’s why we want to make sure the U.S. Food and Drug Administration inspects factories producing food more often than the current average of once per decade.

The FDA also needs to have the power to recall contaminated foods, ensure that imported foods are strictly regulated and require that food companies test their food and report any contamination to the FDA. These are a few of the many necessary reforms we’re working to put in place.

Trust: They don’t have that authority now?

Hearne: No. Right now, for example, the FDA has to ask a company to voluntarily withdraw the product, which takes time. If the company declines or stalls, that kicks off a laborious, time-consuming process, and more people could get sick or die in the interim.

Remember the outbreak that took place early in 2009 involving contaminated peanut butter? I personally call it a “Keystone Cop” incident: Who’s really watching out for the food supply? Ultimately, it was a story about layer upon layer of contractors, consultancies and agencies missing the problem.

The frequencies of inspection would be funny if the consequences were not so serious—the agency’s own data show the FDA is currently equipped to inspect about one percent of the imported products it regulates.

The FDA needs clear authority and resources to do its job of keeping people safe. Again, it’s pretty simple. However, we haven’t had any major reform of the FDA’s food safety law in over 70 years.

Trust: How are you addressing the situation?

Hearne: Earlier this year, we helped establish the Make Our Food Safe coalition, which includes victims of previous food-borne illness outbreaks as well as major consumer and public health organizations. We’re supporting bipartisan legislation called the Food Safety Enhancement Act.

This bill would restore the checks and balances to prevent contaminated foods from getting to your kitchen table—which includes strengthening the FDA’s ability to inspect and recall contaminated foods.

It has been an incredibly powerful experience working with people who have lost loved ones to these outbreaks. We’ve organized a number of events where parents and children have spoken, and, together, we even delivered reusable lunch bags to members of Congress. Instead of a real sandwich, there was a booklet inside that gave specific examples of the risks associated with common lunch items like lettuce, tomatoes and cheese.

We want those bags to be daily reminders that we know how to fix this problem. People shouldn’t have to worry about the lunch they send with their kids to school.

Trust: What keeps you up at night?

Hearne: Losing our antibiotics. As a public health scientist, I am extremely concerned about the infectious diseases that are increasingly resistant to the very drugs we developed to battle them. Two million Americans acquire bacterial infections in U.S. hospitals each year, and 90,000 die as a result. About 70 percent of those infections are resistant to at least one antimicrobial drug, and resistance is growing.

Whether it’s in the food supply—such as Salmonella becoming resistant to antibiotics—or antibiotic-resistant staph infections, diseases that were easily treatable just 10 years ago are now causing greater suffering and death in healthy, vibrant members of our population. More and more, our antibiotics are not doing the trick.

Trust: Why not?

Hearne: Biology 101: The more you use it, the more you lose it. Bacteria are smart little bugs, and they share what they learn with their friends. So when bacteria come into contact with an antibiotic, if they survive, they have learned how to resist that drug.

Trust: Are you saying that doctors shouldn’t prescribe these drugs?

Hearne: Antibiotics should only be prescribed by a doctor or veterinarian when patients are ill or in imminent danger. But antibiotics are being used injudiciously, not to treat sick people or animals, but to speed up growth in animals on industrial farms.

If you ever go to visit one of these facilities, it is mind-boggling. Think of wire cages the size of a file desk drawer crammed with chickens, stacked 40 feet high and as long as a football field. This is not a bucolic setting. This is as stressful as you can imagine.

Science tells us that the more a human or animal is under stress, the more vulnerable they become to disease and sickness. These settings are potential breeding grounds not only for antibiotic resistance, but also for novel viruses that are what a public health scientist worries about most: the emergence of a new deadly virus or bacteria that we’re not able to handle.

It is a danger like this that keeps me and my colleagues focused and committed to our work.

Learn more about Pew's work to eliminate the overuse of antibiotics in food animals through the Pew Campaign on Human Health and Industrial Farming. For the full scope of the Pew Health Group’s work, go to the Health section of pewtrusts.org.

Elizabeth Pitts is an officer in Pew’s Executive Office.

This article appeared in the Spring 2010 issue of Trust magazine.