Fw: Project Censored ~ Milk and Crohn's Disease

[Guest guest]

http://www.mad-cow.org/00/paraTB.html

Paratuberculosis And Crohn's Disease: Got Milk?

by Greger, MD

Updated January 2001

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Project Censored

Microbial foodborne illness is the largest class of emerging infectious

diseases. In 1999, the Centers for Disease Control (CDC) released the

latest figures on the incidence of US foodborne illness considered by the

Food and Drug Administration (FDA) to be the most complete estimate ever

compiled. Seventy-six million Americans every year get food poisoning, more

than double the previous estimate. In today's food safety lottery there's a

1 in 4 chance you'll get sick, 1 in 840 chance you'll be hospitalized and 1

in 55,000 chance that an American will die from foodborne illness

annually.[1]

The CDC estimates 97% of foodborne illness is caused by animal foods.[2]

The latest US Department of Agriculture (USDA) survey, for example, found 9

out of 10 Thanksgiving turkeys--over 90%--are contaminated with

campylobacter, the most common cause of bacterial food poisoning in the

US.[3] And 75% of the turkeys are contaminated with two or more food-borne

diseases, most often salmonella as well, which are becoming dangerously

resistant to many of our best antibiotics.[4]

Although thousands die from food poisoning every year in the United States,

most sufferers only experience acute self-limited episodes. Up to 15% of

those that contract salmonella, however, go on to get serious joint

inflammation that can last for years. An estimated 100,000 to 200,000

people suffer from arthritis arising directly from foodborne infections

each year it the USA. NAME= " fnB5 " HREF= " #fn5 " [5]

The most feared complication of food poisoning, however, is Guillain-Barre

syndrome, in which infection with campylobacter can lead to one being

paralyzed for months on a ventilator. Up to 3800 cases of Guillain-Barre

are triggered by infection with campylobacter every year in the US.

NAME= " fnB6 " HREF= " #fn6 " [6]

Some scientists now fear, though, that an even more serious disease may be

contaminating our food supply. Often touted as the Pulitzer Prize of

alternative journalism, a Project Censored Award was given to what was

considered one of the most censored stories of 1999--the connection between

Crohn's Disease and paratuberculosis bacteria in milk.[7]

Crohn's Disease

Described as a human scourge,[8] over a half million[9] Americans suffer

from this devastating, lifelong condition[10] with annual US medical costs

in the billions.[11] Crohn's sufferers experience profuse urgent diarrhea,

nausea, vomiting, and fevers.[12] Because of the diarrhea, many people are

unable to leave their houses; others drive around in recreational vehicles

or mobile homes to keep a bathroom close at hand.[13] The director of the

National Association for Colitis and Crohn's Disease says the best way to

describe the disease to non-sufferers if to have them think of the worst

stomach flu they ever had and then try to imagine living with that every

day.[14]

What happens is that the immune system starts attacking the lining of the

gut, which becomes swollen and inflamed.[15] In extreme cases this painful

embarrassing condition can affect any part of the digestive system from the

mouth to the anus.[16] This inflammation narrows the digestive tract and

can result in excruciating pain during digestion as well as constant

uncontrollable bowel movements. Added discomforts associated with Crohn's

disease include severe joint pains, weight loss and lack of energy.[17]

The intestines characteristically become so deeply ulcerated that they take

on a " cobblestone " appearance. The ulcers can actually eat right through

the gut wall and cause bleeding, abscesses, fistulas and perforation.[18]

Passing food, sometimes even just drink, through Crohn's damaged intestines

can be excruciatingly painful. In the words of one colon-rectal surgeon,

" Crohn's is a surgical disease. We wait until the patient can no longer

withstand the pain anymore, and then we perform surgerySand repeated

surgeries over timeSultimately, as recurrences happen and intestinal

damage occurs, we just cut 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 twenties--destroying their health.[20] Children, adolescents, and

young adults suddenly become faced with the harsh reality of a 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 on

the increase. The incidence in the US, which has been increasing steadily

since the 1940's--doubling, then tripling, then quadrupling[23]--is now

approaching that of an epidemic.[24] The most rapid increase has been seen

in children. In the 1940's and early 1950's there were no recorded cases of

Crohn's in teenagers. Currently one in every six new cases diagnosed are

under age twenty.[25] Dr. Crohn, who described one of the first series of

cases back in 1932,[26] wrote decades later " From this small beginning, we

have witnessed the evolution of a enstein monster... " [27]

e's Disease

Crohn actually didn't discover Crohn's disease. The first person to give it

a clear description was a ish surgeon named Kennedy Dalziel in

1913.[28] He wrote " 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 difficulty. " [29] Eighty-eight years later

and the scientific community is still not sure what causes Crohn's, but

Dalziel had a hunch which a growing number of prominent scientists now

think may be correct.

About two decades earlier in 1895, German doctor H. A. e was the first

to describe the cause of a disease in cattle characterized by chronic or

intermittent profuse intractable diarrhea.[30] Clinically, the disease in

cattle was virtually identical to that which we now know as human Crohn's

disease.[31] The gross pathology of the infected cow's intestines likewise

had the same cobblestone appearance and microscopically, the Crohn's

diseasedintestines and the diseased cattle intestines were dead

ringers.[32] Dalziel wrote that the tissue characteristics were " so similar

as to justify a proposition that the diseases may be the same. " [33] He

theorized that the disease in cattle and the disease in people were the

same entity.

Mycobacterium paratuberculosis

The cattle disease, which became known as e's disease (pronounced

yo-neez), is known to be caused by a bacteria called Mycobacterium

paratuberculosis, also known as Mycobacterium avium subspecies

paratuberculosis, or MAP.[34] MAP belongs to an infamous class of microbes

called mycobacteria which cause diseases such as tuberculosis and leprosy.

In fact, before e properly distinguished MAP from other mycobacteria,

the disease in cattle was thought to be caused by intestinal bovine

tuberculosis, hence the name paratuberculosis or " tuberculosis-like. "

Mycobacterium paratuberculosis is one of the most enigmatic bacteria

known.[35] It lives inside the hosts' cells, but has no known toxins and

doesn't seem to damage the cells.[36] The damage, much like in diseases

like hepatitis, comes from the hosts' reaction to it. MAP triggers a

massive immune reaction against the body's own tissues in which MAP is

hiding, in this case the gut.[37] It is known that M.

paratuberculosis--MAP--causes e's disease in cattle, but does it cause

Crohn's disease in people?

Spheroplasts

Paratuberculosis bacteria seem to cause disease in almost every species of

animal so far studied.[38] It's reasonable to assume the same might happen

in humans. ParaTB causes a specific chronic inflammation of the intestines

of cattle, sheep, deer, rabbits, baboons, and three other species of

primates.[39] The problem for Dalziel was that he couldn't visualize the

bug microscopically in the surgically resected intestines of patients with

Crohn's.[40]

While one can easily pick out MAP in most cases of e's disease with a

simple light microscope, to this day attempts to stain and view MAP in

Crohn's disease has been largely unsuccessful.[41] The landmark of most

mycobacterial infections is the presence of acid-fast bacilli, so called

because the mycobacterial cell wall soaks up and retains a particular acid

stain.[42] Although failure to see acid fast bacilli in general is not

uncommon,[43] in the intestines of e's disease infected cattle, one can

see swarms of acid-fast bacilli; in Crohn's there are none. The mystery

wasn't solved until 1984, when Rodrick Chiodini, a microbiologist at Brown

University's Rhode Island Hospital published a landmark study in which he

actually cultured live paraTB germs from the gut walls of children with

Crohn's disease.[44]

It has now been well established that paratuberculosis (and some other

mycobacteria[45]) can shed their cell wall and exist as a what has been

termed a " cell wall deficient " or " spheroplast " form. Since it's the cell

wall that picks up the stain, this form of the bacteria cannot be detected

using the acid-fast stain test.[46] The bug, however, can then reform its

cell wall even years later and revert back to its normal stainable self,

which is what happened in Chiodini's lab.[47] It is thought that this

cell-wall deficient form is responsible for triggering the abnormal immune

response which leads to Crohn's disease.[48]

Live Cultures

The next hurdle was the difficulty of consistently culturing the bug from

Crohn's sufferers' intestines.[49] Although MAP has been independently

isolated across three continents--cultured from Crohn's tissue in

California, Texas, France, Australia, England, the Netherlands, and the

Czechrepublic[50]--results are still relatively sparse and many labs have

reported not being able to culture it at all.[51] This is not

surprising.[52]

In order to isolate a specific bug from the multitude that exist naturally

in the intestine, one has to devise a decontamination technique that kills

other bacteria without harming the target bacterium, in this case MAP.

Without it's protective cell wall, however, cell wall deficient forms are

almost impossible to culture because of the caustic processing techniques

required to isolate them.[53]

Even once isolated, MAP is very difficult to grow.[54] Researchers have

been trying since 1952 to grow mycobacteria from surgically removed Crohn's

disease tissue.[55] It is thought that Chiodini succeeded where others had

failed because of his many years of experience, combined with access to

modern culture techniques and years of patient work.[56] Some human

isolates took up to six years to grow, even under extremely precise culture

and decontamination conditions.[57] Earlier researchers failed to meet

these stringent standards for culturing the bacteria.[58]

Even modern labs have been found to be relying on faulty study design.[59]

Moreover, the differences in methods used between labs can be vast.[60]

Some labs still use fixed or frozen specimens or use only surface tissues

from superficial biopsies, when it's been shown that one should optimally

use fresh[61] resected tissue, as MAP tends to be found deep in the

intestinal wall.[62] Some labs working with nonspheroplast forms of MAP

from cattle haven't even been able to 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 lab at all. For example, scientists have never been able to isolate

Mycobacterium leprae, the microbe responsible for leprosy. Even

campylobacter, which we now know as the most significant bacteria in food

poisoning, wasn't identified as a human pathogen until the 1970s, when

culturing techniques enabling isolation were finally developed.[64]

Complicating attempts to culture the bug in Crohn's, there seem to be very

few MAP actually involved in the disease process. This has a parallel in

other animals--MAP bacteria in sheep and goat paratuberculosis are often

sparse or even undetectable[65]--and in other mycobacterial human diseases

like a type of leprosy in which just a few mycobacteria are capable of

triggering a pathological immune response.[66]

DNA Fingerprinting

Obtaining Crohn's tissue samples is easy--patients are all too frequently

having pieces of their bowel removed--but growing MAP from this tissue is

so difficult that a non-culture based method was needed. This advance came

in the late 1980's when new DNA fingerprinting techniques arrived on the

scene.[67] Using DNA probe technology similar to that used in forensic

cases to pick up minute amounts of DNA, one can determine the definite

presence of paraTB without needing to actually culture and grow it.[68] No

longer would researchers have to wait months or years for the spheroplasts

to revert 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,

compared to only 4% of those with the similar but different disease

ulcerative colitis.[69] As techniques for extracting and isolating DNA have

become better and better, MAP has been found in intestinal Crohn's tissue

with increasingly positive results.[70] The reason more Crohn's cases were

not detected is because the test has a limited sensitivity, especially when

searching for a needle in a haystack in the gut which is awash in the DNA

of billions of other bacteria.[71] DNA probe detection of other low

abundance bacterial pathogens, particularly in chronically inflamed

tissues--diseases like tuberculosis, Lyme disease, brucellosis and

lymphocytic leprosy--have similarly been fraught with difficulty.[72]

Isolating chromosomal DNA from mycobacteria in general is experimentally

difficult.[73] There are also other substances in the gut that have been

found to inhibit the test such as bile salts and polysaccharides.[74]

Also accounting for uncertainty in the data[75] is the frequent

misdiagnosing of Crohn's disease. For example, it's been shown that at

least 20% of people diagnosed with Crohn's actually have a different

disease, such as ulcerative colitis.[76] There is also considerable debate

on whether or not Crohn's is a single disease entity in the first

place.[77] Crohn's may be more of a catchall syndrome describing a number

of different conditions, some of which may not be caused by MAP.[78] Either

way, this makes it difficult to interpret data that show that not all of

those we consider to have Crohn's disease test positive for MAP.

As expected, some people without Crohn's--healthy controls--test positive.

Yet just because someone comes in contact with and harbors a specific germ

doesn't necessarily mean that person will come down with the disease.[79]

It is estimated, for example, that only 1/3 of calves that ingest MAP ever

develop e's.[80] It is also possible, like closely related subspecies,

that there are different strains of MAP, some of which cause disease and

some of which don't.[81] The important point is that there has consistently

been a highly significant specific association between Mycobacterium

paratuberculosis and Crohn's disease.[82]

Association or Causation?

Just because Crohn's sufferers are much more likely to have MAP found in

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 of MAP into diseased tissue, leading to a chicken and egg scenario

of which came first.[83] If MAP just has an affinity for inflamed tissue,

however, one would expect that one would also find MAP more frequently in

biopsies of similar diseases like ulcerative colitis, but this is not the

case. Conversely if you look for the DNA of other nonspecific mycobacteria,

one finds that they are uniformly distributed between Crohn's patients

versus controls. This finding is consistent with the known environmental

distribution of mycobacteria, which are present in 30-50% of all

environmental samplings--including water, soil, even air.[84] So other

mycobacteria people routinely come in contact with, even the closely

related Mycobacterium avium subspecies silvaticum, are equally distributed

among people whether they have Crohn's disease, or colon cancer, or are

completely healthy as one might expect.[85]

In medicine there is a method used to try to prove that a specific pathogen

causes a specific disease. The first person to definitively prove that a

disease was caused by a particular organism was Koch, who uncovered

the bacterial origin of anthrax in 1876. Koch cultured the bacteria from a

diseased animal, gave anthrax to a healthy animal by inoculating her or him

with a pure culture of the bacilli, and then was able to recover and

reculture the bug once again.[86] These experiments fulfilled criteria

proposed 36 years earlier by Henle as necessary to establish a causal

relation between a specific agent and a specific disease. These criteria

are now known as the Koch postulates.[87]

Not only are these experiments arguably unethical,[88] they also can be

unreliable in clinical medicine, as other animals may not be susceptible to

the same diseases that we are. For example, the case to prove that H.

pylori caused ulcers was hindered by animal research, as rats and pigs were

tested and seemed to be immune.[89] For this and other reasons, there are

some recognized infectious diseases which have never fulfilled Koch's

postulates. Leprosy, for example, has still never fulfilled more than one

of the four criteria, because it is not possible to culture the culprit

bacterium in the laboratory. Nonetheless, Mycobacterium leprae is known to

be the cause of leprosy, and leprosy is known to be an infectious

disease.[90] So while not absolutely necessary to fulfill Koch's postulates

to prove causation, they are the most widely accepted method. So

researchers set out to the task and they succeeded--twice.[91]

Chiodini fed chickens pure cultures of the paratuberculosis bacteria he

recovered from the surgically removed intestines of children with Crohn's

disease. The chickens then developed an intestinal disease resembling

Crohn's.[92] In 1986, a different lab fed infant goats a human strain of

paratuberculosis and also found that the bacteria induced a Crohn's-like

intestinal disease in the goats. The same strain was then recovered back

from all of them.[93] When asked why there continues to be so much

resistance against the idea of MAP as a cause of Crohn's disease, Chiodini

replied " What you have to realize is that there is a lot of politics in

medicine. It's not whether you have the proof of something, but whether or

not the medical community wants to acceptit. " [94]

Because there have been so many other failed attempts to figure out the

cause of Crohn's, the medical community is very leery of new proposed

causes, especially infectious ones.[95] The gastrointestinal community

maintains a healthy skepticism regarding new pathogens as the cause of

Crohn's disease, because different pathogens suspected in the past, such as

chlamydia and measles, have since been disproven.[96] Of all the pathogens

once thought associated with Crohn's in the 80 years it's been researched,

MAP is the only one directly cultured and the only one capable of causing

pathologically indistinguishable disease in other animals.[97]

The way that doctors test for the presence or absence of many infectious

diseases is by looking for specific antibodies that our immune system uses

to target the invader. When we test for HIV, for example, we are not

usually testing for the virus directly, we are looking for the presence of

anti-HIV antibodies.[98] If they're found, we can be relatively certain the

person has been exposed to HIV. Similar searches have been launched for

anti-MAP antibodies. Unfortunately scientists have had difficulty finding

an antibody which is specific for MAP.[99] There are some promising new

suspects, however, which are thought to be unique to MAP and have been

found in 90% of Crohn's patients, but in less than ten percent of those

with ulcerative colitis.[100] These results not only support the theory,

but open new research frontiers. A vaccine might be developed and the

diagnosis of Crohn's may soon be just a blood test away.[101]

Epidemiology

Other potential lines of evidence include population studies. One would

expect that if paratuberculosis was causing Crohn's disease, then the

regions in which there is a high prevalence of Crohn's should overlap with

the regions with a high prevalence of paratuberculosis. While sufficient

data is lacking,[102] a review of the epidemiology of e's disease

compared with the epidemiology of Crohn's disease found just that.[103]

" Crohn's disease has a very spotty distribution in the world, " notes Dr.

Walter Thayer, an expert on the disease at Rhode Island Hospital who worked

with Chiodini to culture MAP from Crohn's patients. " But it's seen only in

milk-drinking areas--Australia, southern Africa, Europe, the United States,

Canada, New Zealand. Interestingly, it's not seen in India, where they do

drink milk, but they boil it first. " [104]

Critics point to Sweden, which has its share of Crohn's, but whose cattle

are reportedly paratuberculosis free. Unfortunately, the surveillance

testing has been limited.[105] , veterinarian and

microbiologist with the University of Wisconsin, has written " We believe no

region in the world is free of M. paratuberculosis infection in its

ruminant livestock. In all likelihood, e's disease is to be found in

every country. Being free of the disease isprobably more a function of how

hard one has looked than a true lack of incidence. " [106] We will see a

prime example of this in the discussion of Ireland.

Another perceived inconsistency in the link between paraTB and Crohn's is

the fact that Crohn's is found more often in urban, rather than rural

populations.[107] Dairy farmers, for example, do not seem to have higher

rates of Crohn's.[108] This is not dissimilar from other parallel diseases

like bovine TB--tuberculosis not paratuberculosis--which, centuries ago,

was responsible for the deaths of hundreds of thousands of children who

drank unpasteurized milk.[109] The association between tuberculosis

contracted by drinking milk and the rural community was also weak,

presumably because of the commercial marketing and distribution of infected

milk.[110]

Any explanation of Crohn's would have to account for the rapid increase

seen in this disease this century.[111] The longest continuous study of the

incidence of Crohn's disease is from Wales, which reports a 4000% increase

of the disease since the 1930's.[112] This may be explained by the

concurrent rise in paratuberculosis in intensively farmed dairy herds

throughout the century.[113] Thayer asks also " What has happened to

dairying in that time? Do you get milk from your local dairy? No. You get

it from big conglomerates that buy from local dairies and pool all the

milk. I think this is possibly the reason the disease has spread so

quickly. " [114]

Nick

Two centuries ago, when milk drinking children were dying en masse from

bovine TB, one of the earliest signs that they had drunken milk from a

tuberculous cow was an infection of the lymph nodes that drained the

throat. Scientists think milk is also the source for human exposure to

paratuberculosis, so they wondered if the same thing happened with MAP.

Enter Nick , a 7 year old boy who developed a painful swollen lump on

the right side of his neck. His family took him to see their doctor, who

decided it needed to be biopsied. The biopsy clearly showed he was infected

with paratuberculosis. This is significant because it was the first

definitive proof that paratuberculosis could infect human beings and cause

disease. He and his family waited. Five years later, Nick came down

with Crohn's disease.[115] Despite the clear cut case description of a

human paratuberculosis infection followed by the development of Crohn's,

the medical communitycontinued to ignore the growing evidence indicting

MAP. There are many precedents of similar resistance to new ideas in the

medical field.

H. pylori

Most ulcers are caused by the immune system attacking the lining of the

stomach. Doctors blamed stress, thinking this led to too much stomach acid

and the excess acid caused irritation which maybe triggered the attack. It

was treated the same way as Crohn's has been treated: symptomatic relief of

the inflammation and surgery. Then two Australian researchers cultured a

tiny bacterium from the lining of the stomach and hypothesized heresy--that

ulcers were actually caused by an infection.[116]

For almost a decade the researchers' ideas were dismissed and

ridiculed.[117] The medical community scoffed at the notion that bacteria

could survive in stomach acid.[118] One of the Australian researchers was

so desperate that he actually drank a vial of the bacteria to prove his

point.[119] What finally convinced the medical community, though, was that

ulcers disappeared when patients were treated with the right

antibiotics.[120] This discovery revolutionized thinking in medicine. The

ulcer-causing bacteria, H. 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. Just as H. pylori bacteria were the real reason the body was

attacking the stomach lining in ulcers, researchers think that the MAP

bacteria are the reason the body is attacking the intestinal lining in

Crohn's. The proposition that ulcers were an infectious disease was met by

nearly universal skepticism in the medical community.[122] As Dr.

Hermon-, Chairman of the Department of Surgery at St. 's

Medical School in London and leading proponent of the paraTB-Crohn's link,

has noted, " And this [H. pylori] was a bug that you could see by looking

down the microscope, grow in a simple culture system in the lab, test for

immunologically pretty simply, and ordinary tablets readily available to

doctors could make it go away. And it still took eight years for the penny

to drop. Now we've got a bug [MAP] that you can't see, can't grow, hides

under the immunological radar, is a bastard to kill, and the problem it's

causing is far, far greater. If Rod Chiodini and I are wrong, the magnitude

of the problem will only be the economic losses of farm animals, which is

costing the US somewhere between $1.5 and $2 billion a year. If Rod

Chiodini and I are right, then, oh 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 that

their best bet at convincing the world that MAP causes Crohn's lay in

trying to cure Crohn's--a disease thought incurable--with appropriate

antibiotics.[125] Of course there was no guarantee that even if the disease

were caused by MAP that it would respond to treatment.[126] For example, we

can cure most pulmonary TB with antibiotics, but when TB bacteria move from

the lung to the intestine and cause intestinal TB, it cannot typically be

cured by antibiotics alone.[127] Researchers, though, set out to try.

Before we knew that ulcers were treatable with simple antibiotics, people

underwent repeated grueling surgeries--some almost as risky and

debilitating as Crohn's sufferers now undergo. Not only would a cure save

Crohn's sufferers from the surgeon's knife, but it would also protect them

from the toxic chemotherapy regimens currently used just for symptom

relief, which can include immunosuppressants like steroids, cancer chemo

agents[128] and even thalidomide.[129]

Researchers started trying antibiotics they thought might kill MAP in

Crohn's. Early results were disappointing,[130] leading to much of the

deep-seated resistance among clinicians to accepting MAP as the cause of

Crohn's.[131] Yet in hindsight, it turns out tht doctors were using the

wrong antibiotics, in the wrong combinations, for an inadequate period of

time.

Perhaps because of the name similarity, many researchers assumed that

antibiotics effective against M. tuberculosis should also be effective

against M. paratuberculosis.[132] They were wrong; when one actually tested

antibiotics against MAP in a lab, researchers found that it was in general

resistant to anti-tuberculous drugs.[133] They didn't work in cows[134];

they don't work in people.[135]

Another problem with some early studies was that they used

monotherapy--meaning that they only used a single agent--which is rarely,

if ever, effective in mycobacterial diseases because mycobacteria are so

adept at developing resistance.[136] By giving multiple antibiotics at

once, one decreases the chance that resistance will develop.

Adequate treatment duration had also been neglected. Mycobacterial

infections in general are difficult to eradicate; prolonged treatment is

required and relapses, either on treatment or off treatment, are

common.[137] Tuberculosis takes months to treat; leprosy takes

years--sometimes a lifetime--to treat. Our best estimate of how long it

might take to rid the body of MAP can be made by studying pathogens in the

same species. Infections caused by one of MAP's closest cousins routinely

require treatment for 3-4 years with 3 or 4 different antibiotics.[138] In

some cases, it took five antibiotics all used in combination for 5 years

before clinical improvement was achieved. We cannot expect trials using too

few drugs, the wrong drugs, or even the right drugs for too short a time,

to be successful.[139]

There are some factors which complicate any trial, even if the agents are

chosen and used appropriately. Crohn's can be a cyclical disease, with

periods of flare-ups and remissions, so approximately 20% of Crohn's

patients during a treatment period will spontaneously improve on their own.

The placebo effect is 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 disease--20% of people diagnosed with Crohn's may

actually have something else.[140] There is also clinical, epidemiological,

and molecular evidence indicating that there are two distinct clinical

manifestations of Crohn's disease, which each 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

of just blindly trying different antibiotics, scientists actually endured

the laborious task of testing the antibiotics one by one on MAP in the lab.

The breakthrough came in 1992 when the newly developed antibiotic

clarithromycin was found to be the most effective known killer of

Mycobacterium paratuberculosis. Many of the antibiotics used earlier worked

by blocking cell wall synthesis. But Crohn's is thought to be caused by the

spheroplast form of MAP which doesn't have a cell wall; it's therefore no

wonder these earlier drugs didn't work. Clarithromycin, and an antibiotic

called rifabutin, have a different mechanism of action, blocking protein

synthesis.[143]

Another reason why drugs like clarithromycin (called macrolides) work

against paraTB where others have failed is that MAP is an intracellular

pathogen. They live inside our cells (another reason why they're so hard to

see under a microscope). Only certain antibiotics, like macrolides, can

penetrate inside human cells and still work effectively.[144] None of the

previous MAP trials properly evaluated these newer macrolide

antibiotics.[145] The 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] Researchers

chose to use rifabutin and clarithromycin because they seem to complement

or synergize with each other.[147] The treatment was named RMAT, Rifabutin

and Macrolide Antibiotic Therapy.

Fifty-two patients with Crohn's disease, most of whom had persistent severe

symptoms resistant to conventional treatment, were studied. Six patients

had to be excluded, due mostly to intolerance to the antibiotics,[148]

though in general the RMAT medications tend to have a much higher tolerance

rate and far fewer side effects than the current immunosuppressive drugs

used for Crohn's.[149] The remaining 46 patients were treated with RMAT for

about a year. Of the 46 patients who were able to tolerate RMAT, 43 went

into clinical remission, for a remission rate of 94%.[150]

A two-year follow-up was performed. The majority of patients in whom a

clinical remission was initially induced remained symptom free off of all

their previous medications.[151] Similar trials in other centers have

reproduced these findings.[152],[153],[154],[155],[156] The fact that some

patients relapsed after treatment was stopped may point to the difficulty

in eradicating the organism or perhaps that they had been re-infected.[157]

Hermon-, one of the principal investigators of the original trial, is

currently recommending patients take RMAT regimen for at least 2 years.

Among patients who respond to treatment, remission occurs slowly over the

first three to six months of treatment. Symptoms often get worse before

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

any known treatment for Crohn's disease and the lowest reported relapse

rate, including all current immunosuppressive treatments.[159] Thought to

be an incurable disease, doctors seem to have been able to induce profound

long-term remissions in the majority of patients with Crohn's disease.[160]

Not only do patients stop having symptoms, but their intestines actually

show evidence of healing, an unprecedented achievement.[161] " If this were

cancer, " said one RMAT researcher, " we would be calling these long

remissions a cure. " [162] Hermon- told the press " I've seen people who

were without hope get better like magic. I've been a doctor for nearly 40

years, and it's the best thing I've ever seen in clinical medicine. " [163]

Though the preliminary results of this and other pilot studies are

encouraging, Hermon- is the first to point out the limitations of the

study--it was too small and there were no controls.[164] " We were actually

denied the funding to do a randomized control trial, " he said. " So I did

the best that I could with what I've got. " [165] To date, according to the

Cleveland Free Times article that won 1999's Project Censored Award,

twenty-five of Hermon-'s grant proposals submitted both here and

abroad were rejected.[166]

Chiodini estimates he's similarly submitted over two dozen grant proposals

to the National Institutes of Health, the USDA and the Crohn's and Colitis

Foundation of America, but to no avail.[167] Drugs 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 largest

corporations in the world of billions of dollars (anti-ulcer medications

were the world's best-selling prescription drugs), the drug industry scores

huge profits from increasingly complex and expensive maintenance Crohn's

treatments, which must be administered for the rest of the patient's

life.[168] Needless to say, financial support from the corporate sector has

not been forthcoming.[169]

Nevertheless, these preliminary results must be reproduced to be seriously

considered. Larger scale controlled studies are currently in progress to

obtain better data.[170] The most promising is a phase III clinical trial

of RMAT in Australia which has been designed as a double-blind,

multi-center, controlled clinical trial involving over 200 patients with

Crohn's in at least seven major cities across the continent.[171]

Unfortunately, they seem to be having a problem securing patients for the

study.[172] A controlled RMAT trial has also reportedly been initiated by

the National Institutes of Health.[173]

Milk and Pus

Professor Hermon-, internationally known expert on Crohn's and MAP

genetics, who has researched the illness for 20 years, said: " If there were

no MAP I believe there would be almost no Crohn's disease. It is certainly

responsible for between 60 per cent and 90 per cent of all cases and I

would think that it is more likely to be 90 per cent. " [174] Obviously,

everyone who's exposed to paraTB doesn't come down with Crohn's disease, as

is the case in virtually all infectious diseases. As mentioned previously,

just because one comes in contact with a pathogen does not necessarily mean

one comes down with the illness. Genetic and environmental factors

facilitate establishment, persistence, and production of disease.[175]

H. pylori, for example, (the bacterium proven to cause ulcers) is one of

the most common of all bacterial infections[176]--a third of Americans have

H. pylori in their stomachs.[177] A third of us, however, don't have

ulcers;[178] some people are just susceptible. Similarly, only about one in

three hundred people exposed to tuberculosis actually come down with active

disease.[179] Until we know why some and not others fall ill, all one can

do is to try to minimize exposure to the pathogen. For example, people

should not let those with tuberculosis cough in their face.

Drinking milk from cows infected with e's disease is how people are

exposed to paratuberculosis. Based on DNA fingerprinting techniques, there

are two strains of MAP: one that affects cattle, and one that affects goats

and sheep. All human isolates so far have been of bovine origin,[180]

implicating milk.[181] Milk is the " logical " focus of exposure[182] because

cows with e's disease secrete paraTB abundantly in their milk.[183]

Even sub-clinical cows--those that are infected but appear perfectly

normal--shed paraTB bacteria into their milk.[184] Although these bacteria

are found free-floating in milk, their transmission may be facilitated by

their presence inside pus cells.[185] This is a particular problem in the

United States, as we have the highest permitted upper limit of milk pus

cell concentration in the world--almost twice the international standard of

allowable pus cells.[186] By US federal law, Grade A milk is allowed to

have over a drop of pus per glass of milk.[187] These pus cells may

facilitate the transmission of paraTB.[188]

Pasteurization

In England, researchers took milk off grocery shelves and tested it for the

presence of paratuberculosis bacteria using DNA probes. Depending on the

time of the year, up to 25% of milk cartons contained paratuberculosis

DNA.[189] Interestingly, the seasonal variation coincided with the periods

when Crohn's patients tend to suffer relapses.[190] The researchers tried

to culture live paraTB bugs from the milk, but were largely unsuccessful,

because cow's milk is such a stew of microbes that fungal overgrowth and

faster multiplying bacteria took over the samples.[191] The question then

remained, did the positive DNA samples in up to a quarter of the milk

supply indicate live or dead paratuberculosis bacteria? Can paraTB survive

pasteurization?

Historically, pasteurization had been established in order to kill paraTB's

cousin, bovine tuberculosis.[192] TB was thought to be one of the most heat

resistant human pathogens, so the temperature was set at approximately 62o

Celsius (144o Fahrenheit) for a half an hour.[193] Later, the disease Q

fever was discovered, so the temperature was increased to 63o Celsius.[194]

Now the HTST method, which stands for High Temperature, Short Time, is

predominantly used--72o Celsius (162o F), but only for 15 seconds.[195]

While 72o C kills most bacteria, paratuberculosis has been shown to survive

15 seconds at 90o Celsius (194o F).[196] By hiding in milk in fat droplets,

pus cells, and fecal clumps,[197] paraTB might be able to survive at even

higher temperatures.[198] Second only to prions[199] (which cause mad cow

disease), paratuberculosis is considered the most heat resistant pathogen

in the human food supply.[200]

e's on the Rise

According to the Food and Agriculture Organization of the United Nations,

e's disease is one of the most serious diseases affecting the cattle

industry.[201] Although it is found in cattle populations throughout the

world, the United States appears to have the worst paratuberculosis problem

on the planet.[202] In 1997, the USDA released a long-awaited report of the

national prevalence of e's disease. Surveying over 2500 dairy

producers,[203] they showed that between 20-40% of US dairy herds were

infected, a figure that they concede is probably an underestimate.[204]

Since milk from an entire herd is likely to be pooled together in tankers

for transport to processing plants, the 20 to 40% figure is likely to

indicate the level of contamination in American milk.[205]

Just as Crohn's disease is increasing in the human population--it may be no

coincidence that the US also has the world's highest incidence of Crohn's

ever recorded[206]--e's disease is spreading among dairy cattle.[207]

e's disease is spread primarily by the fecal-oral route. One can

imagine how a cow with intractable diarrhea can thoroughly contaminate her

surroundings[208] and just a few bits of swallowed manure can potentially

infect a calf.[209] Overtly infected animals, losing up to 300 lb. of body

weight in one week[210] can shed as many as ten hundred trillion bugs a

day.[211] One can also imagine what intensive modern farming practices have

done for the disease.[212] Grazing bigger and bigger numbers of cattle on

smaller and smaller plots of land is one of the reasons this dreaded

disease is such a growing threat.[213] And every time animals are

transported between farms, new herds may be infected. If no changes are

made, the dairy herd infection rate is expected to reach 100%.[214]

USDA Farce?

With the growing e's epidemic, US governmental regulatory agencies have

been in a bind. The only thing allegedly standing between people and the

paratuberculosis bacterium are 15 seconds at 72o Celsius.[215] The

government has had to somehow convince the families of Crohn's patients who

started to ask questions that pasteurization was foolproof. The problem was

that the preponderance of the scientific evidence was against them--almost

every study ever done simulating pasteurization conditions showed that

paraTB survived 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

their pasteurization experiment by first crippling the bacteria. Very

irregularly, with no precedent in the scientific literature for using this

type of approach,[217] the USDA began their experiment by first " starving "

the MAP bacteria,[218] exposing them to high-frequency sound waves, and

freezing them--a technique that has been shown conclusively to weaken

MAP.[219] They were also criticized for making a number of methodological

mistakes and omissions.[220],[221] Then, allegedly to make absolutely sure

not a single bug would grow, they used an inadequate culture media[222] and

report culturing them for only 2 to 3 months.[223] It is widely accepted

that the minimum time it takes to ensure the growth of paraTB is 4

months.[224]

It is perhaps not surprising that no MAP grew from the pasteurized milk in

their experiment. The researchers concluded: " Results indicate that the

transmission of live paraTB bacteria via pasteurized milk is unlikely. "

Despite fifteen[225] years of better research to the contrary,[226] based

on that single questionable study, in a letter dated Feb. 9, 1998, ph

Smucker, the leader of the FDA's Milk Safety Team wrote " After a review of

the available literature on this subject, it is the position of FDA that

the latest research shows conclusively that commercial pasteurization does

indeed eliminate this hazard. " [227]

The FDA has argued that earlier pasteurization studies used unrealistically

high levels of MAP that wouldn't be expected to exist naturally in the raw

milk supply.[228] This is not a tenable criticism, primarily because the

studies in question followed the published guidelines on the proper

challenge concentration in the design of thermal inactivation studies.[229]

Also, the concentration of MAP in raw milk is unknown. Cattle infected with

e's disease have uncontrollable diarrhea, which " sprays " out from them

in liquid form. Due to the close proximity of the cow's anus to her udders,

it is unavoidable that an infected cow's udders will be smeared with feces,

potentially leading to the contamination of her milk with high numbers of

Mycobacterium paratuberculosis.[230] The feces contaminating her milk can

have as many as a trillion paraTB bugs per gram.[231]

Off the Shelf

Despite its shortcomings, the USDA study continues to be cited and the rest

of the scientific literature ignored by the government and the agricultural

press.[232] Hoard's Dairyman, for example, cited the USDA study and

concluded that " pasteurization destroys this dangerous disease. " [233] It

wasn't until the year after the study was published that such assertions

were proven to be wrong.

The only way to demonstrate for sure that live paraTB bacteria survive

pasteurization is to culture a colony of living paratuberculosis bacteria

from retail pasteurized milk off the grocery shelf. In 1998, that is just

what researchers did. Choosing Ireland, which has the highest per capita

milk consumption in the European Union,[234] investigators went to 16

retail outlets and got 31 cartons of milk which were pasteurized at

commercial dairies large and small.[235] Six grew out live paraTB,

19%--almost 1 in 5.[236] This caused a national food scare with daily front

page headlines, not a word of which crossed the Atlantic.

In an editorial entitled " Media and Censorship, " the Editor-in-Chief of the

Cleveland Free Times wrote " The dairy lobby is notoriously powerful inside

the Washington D.C. beltway. And a tax on dairy farmers helps the dairy

industry spread its advertising dollars around generously (most notably the

'Got Milk?' ad campaign), to the point where the wholesomeness of milk goes

virtually unquestioned in the media. How else can it be explained that the

possible link between a bacterium in milk and Crohn's disease is virtually

unknown in the United States, despite front-page coverage in England and

other places around the world. " [425]

When the results of the Irish study were released, crisis management

specialists called the ramifications " enormous, " " horrific. " Dairy industry

experts described it as a " significant blow to the industry, " " accelerating

the long-term decline of milk, " and noting " It's not a market that can just

bounce back. " [237] Dairy industry leaders reacted angrily to the suggestion

that pasteurization was inadequate. The British National Dairy Council's

" Information Officer, " said she wished the investigators had contacted the

industry before publishing their scientific findings.[238]

Responding to public pressures, the British government initiated a

nationwide thousand-sample survey of retail pasteurized milk. The

announcement splashed headlines all over Europe, but there was still no

word in the American press.[239] The preliminary findings of the British

government's survey were released in April, 2000. Three percent

NAME= " fnB240 " HREF= " #fn240 " >[240]--3 out of every one hundred cartons of

milk off the shelves--grew out live paratuberculosis bacteria,[241][242]

Based on the detection threshold of these tests, each quart had to contain

at least about a million paraTB germs to come up positive.[243]

A year and a half earlier, after the announcement that milk was

contaminated by at least paraTB DNA, the three British supermarket

giants--Tesco, Sainsbury and Safeway--announced that milk pasteurization

time would be increased from 15 seconds to 25 seconds, to reassure the

public that their products were safe.[244] The finding of live

paratuberculosis bacteria in retail milk over a year later has fueled the

skepticism that the 10 second change would make any difference.[245] The

change was not based on science--in fact there is a suggestion that some

paraTB can survive pasteurization temperatures for 9 minutes[246] or

longer.[247]

Public Relations

Despite the release of these findings, the British Agriculture Minister

said on national television: " I drink pasteurized milk and it is safe to do

so... with confidence, " a claim reminiscent of a previous Minister's

assurances about beef from cattle infected with mad cow disease.[248]

According to the Royal Statistical Society, contaminated beef still has the

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 death imaginable.[249]

The same assurances are echoed in the US. For example, the director of the

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 old. " [250] The FDA chooses to continue to base national safety

policy on the single flawed USDA study,[251] even now that it's been

superseded by proof that its conclusions are wrong (the US mandates the

same pasteurization method that is used in Britain and Ireland).[252]

The FDA's continued insistence that pasteurization eliminates the risk of

contracting paraTB--despite clear evidence to the contrary--puzzled Kurt

Gutknecht, the editor of the highly respected industry publication

Wisconsin Agriculturist. He called up Joe Smucker, the leader of the FDA's

Milk Safety Team, and asked him about the FDA's official " commercial

pasteurization does indeed eliminate this hazard " statement. Smucker

replied that he did not have " clearance from the FDA " to speak to him on

the subject. Surprised at Smucker's reluctance to talk to him, the editor

went to the official FDA spokesperson, who described the refusal of an FDA

official to not respond directly to press inquiries as " very unusual. "

Gutknecht turned his attention back to the Milk 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 sitting on.[255] According to one industry expert, the

incrimination of MAP in human disease would cause enormous economic damage

to animal agriculture industries. An article in Milk Science International

entitled " Mycobacterium paratuberculosis: A possible agent in Crohn's

Disease? " warns that " the present state of knowledge is... potentially

catastrophic for the dairy industry should existing information be used in

a sensationalist manner. " [256]

Hidden Threat

e's disease is one of the most difficult diseases to recognize and

control.[257] This is in part because of MAP's ability to resist

destruction in the natural environment. It has reservoirs in pasture and,

perhaps, in other animal populations. Paratuberculosis has spread, for

example, 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 control, however, is its notoriously covert nature.

Paratuberculosis has been called a " spectral disease, " [259] a " hidden

threat, " [260] an " insidious problem for the nation's dairy herds. " [261]

Although infections are usually initiated during calfhood, clinical disease

does not appear until adulthood.[262] During this incubation period, which

can last between 6 months[263] and 15 years,[264] the infection is

invisible.[265] Sub-clinically infected animals don't have diarrhea or

other typical visible signs of e's, but they are carriers and can shed

the 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 e's disease problem has been likened to the tip of an

iceberg--the so-called " iceberg effect. " [267] By the time a single clinical

case surfaces, five[268] to fifteen[269] or twenty[270] others may be

infected in the herd. If the clinically affected animal had been born on

the farm, a minimum of 25 other animals are probably infected--perhaps as

many as 50--and less than 30% of those would be detectable by currently

available tests.[271]

e's may also be clinically hard to detect. While in some instances the

disease progresses relatively rapidly, with the interval between the

appearance of wasting and death measured in months, in other cases, after

the initial loss of condition, there may be no clinical deterioration for

long periods of time. Since the first signs of clinical disease are

progressive weight loss and a drop in milk production, farmers may just

cull the animal without requesting further diagnosis.[272] Also, like

Crohn's, e's can go into periods of remission which can last for weeks

or even months.[273] Finally, e's can mimic other diseases like

intestinal parasitism, malnutrition, salmonellosis, winter dysentery,

etc.[274]

Traditional control methods have involved culling infected animals and

using hygiene methods to prevent new infections.[275] Removing infected

animals alone has proven ineffective because of the latency period and

because the bacterium survive so well outside the body. As one commentator

noted, " An iceberg is not destroyed by the removal of the tip! " [276]

Another proposal has been to kill off the entire herd, an option termed

" herd disposal. " The plan would then be to disinfect the barns and wait a

year or so before new animals are allowed to pasture. This measure will

likely never be initiated, though, because paraTB is so widespread that the

resulting financial burden would be considered too great.[277]

After culling, the next most effective action is considered to be

segregation of the infected animals.[278] Strict hygiene, down to the

washing of boots, is necessary to prevent cross contamination--only a few

grams of manure are needed to infect a calf.[279] Surveys show that many of

these basic steps are not followed, however. For example, in approximately

a third of operations, the cows' udders are not routinely washed prior to

collecting colostrum or before nursing.[280]

While some calves are infected in utero,[281] removing newborn calves from

the mother immediately upon birth is considered an effective control

measurebecause it eliminates the newborn's attempt to nurse and risk

ingesting infectious manure.[282] Currently, about two thirds of dairy

operations report taking the calf away from the mother within 24

hours.[283] There are fears among the animal welfare community that e's

disease management will intensify this irresponsible[284] 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 crop land. " [285]

Conspiracy of Silence

Despite its pervasiveness and its ability to severely impact milk

production and destroy whole herds of cattle, e's disease remains an

industry problem that is not openly discussed.[286] In an article entitled

" e's Disease: a Dairy Industry Perspective, " e's is described as

" Something that farmers talk about secretly--whisper behind hands. " One

dairy scientist stated that in all his years he had never heard an open,

frank discussion of e's disease and calls for end of the " whispering

campaign. " [287] Dairy farmers try to hide the fact that they have the

disease in their dairy herds.[288] As an article in Cornell Veterinarian

notes, " Farmers prefer not to acknowledge its presence and enshroud suspect

cases with secrecy. " [289] It is a problem that is kept out of sight and out

of mind. As one dairy farmer put it " It's [e'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

entire industry to the point of interfering with scientific dialogue.[291]

From the Journal of Dairy Science: " Fear of consumer reaction... can impede

rational open discussion of scientific studies. " [292] Without doubt, says

Chiodini " the dairy and regulatory industries are concerned vocally... but

their concern is limited to the possibility of 'bad press' to the industry

rather than a concern for the truth or public health. " [293]

The secrecy has successfully bred ignorance. Over a century after the

disease was identified, almost half of all dairy farmers nationally

surveyed by the USDA didn't know anything about the disease.[294] And those

with the largest herds--the herds most likely to be infected[295]--were

found least likely to have known of the disease.[296] Meyer, then

Executive Director of the nonprofit Paratuberculosis Awareness and Research

Association (PARA), placed the blame on the representatives of the dairy

industry. At a meeting of the USDA's United States Animal Health

Association (USAHA), she challenged dairy producers to become more

proactive. " If there are organizations you have been relying on for your

information and to protect your interests, they have failed you

miserably. " [297] " I think we underestimate farmers, " she told the Wisconsin

Agriculturist. " If they even thought they were making someone sick, it

would break their 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 " research, with less than one percent of its animal disease

grant budget allocated to e's.[299] As Alan Kennedy, a co-founder of

PARA and himself a sufferer of Crohn's disease remarked, " yet another case

of CJD--Conflicting Job Description. " The USDA is mandated to regulate

animal industries and food safety, but it is also responsible for promoting

these same agricultural products.[300]

The first US case of e's was discovered in Pennsylvania in 1908.[301]

Almost a century later there is still no mandated control program,[302]

even though as far back as 1922 scientists published warnings of the danger

posed by the disease and outlined effective methods of controlling and

eradicating it. Efforts to control and eradicate e's disease have been

grossly inadequate.[303] " In the 75 years following the release of that

publication, there's very little that any state has done to try to control

the disease, " says , the University of Wisconsin veterinary

researcher. Meanwhile, as predicted in 1922, the disease has continued to

spread silently and surely. According to the USDA's figures, there are now

three quarters of a million cattle infected with paraTB in the United

States.[304]

The reason that e's has spread to such a degree is because there have

been no direct constraints on the transport of infected animals.[305]

Almost without exception, paratuberculosis is introduced into a herd

through the addition of an asymptomatic infected carrier animal. Almost

every infected herd can trace the infection to the purchase of an infected

cow[306] that appeared healthy when offered for sale.[307] Disturbingly,

the USDA found that dairy farmers with infected herds were no less likely

to sell replacement cows to other farms than owners of noninfected

herds.[308]

Regulatory vets know and accept this fact, acknowledging that movement

restrictions on infected animals must exist for an effective control

program. However, as described in the Veterinary Clinics of North America ,

" if the voluntary program imposes movement restrictions, it could quickly

become a regulatory program and not have widespread support and

participation from the livestock industry. " [309] In fact the Code of

Federal Regulations (part 80) was recently changed to remove restrictions

on the interstate movement of e's disease positive animals.[310] The

change was made because of pressure from the livestock industry.[311]

Though not putting its money where its mouth is, the USDA insists that the

agency is doing everything it can with regard to e's disease.[312] The

USDA, for example, cites the formation of the National e's Working

Group in 1994. However, the executive committee of the group is composed of

three people: one is of the National Milk Producers Federation

and another is Weber a director of the National Cattleman's Beef

Association.[313]

For those that remember the Oprah Winfrey mad cow fiasco, Weber was the

cattleman defending cow cannibalism. " Now keep in mind, " he said on that

show, " before you--you view the ruminant animal, the cow, as simply a

vegetarian---remember that they drink milk. " Years earlier he told industry

publication Food Chemical News that the cattle industry could indeed find

economically feasible alternatives to feeding rendered animal protein to

animals raised for slaughter, but that the Cattlemen's Association did not

want to " set a precedent of being ruled by activists. " [314]

Not surprisingly the National e's Working Group has officially come out

against making e's a reportable disease, advocating that all attempts

at control be voluntary.[315] In a moment of rare candor, one Working Group

member explained why: " If the farmers have to report positive cows, then it

will be like the sheep scrapie [mad sheep disease] program. Instead of

reporting the disease, the farmers will 'shoot, shovel and shut up.' " [316]

A year earlier, a national paratuberculosis certification program had been

started in order to identify low risk herds, but only 1% of dairy

operations reported participating in the program, citing associated

costs.[317] Less than 15% of the dairy producers appear to test for

e's.[318] In 1997 the e's Working Group set up a similar program

designed to be more affordable,[319] but again chose to keep it strictly

optional, relying on the " livestock industry in each state to sell its

economic advantage to its members. " [320] As a concession to the industry,

there is still no federally mandated e's Disease control program.[321]

Some states have e's control programs, but without exception they are

noncompulsory.[322] Just as government deregulation of industry may have

led to the mad cow disaster in Europe, the lack of industry accountability

may also play a pivotal role in the human consequences of the

paratuberculosis epidemic.[323]

The United States is being left behind in the world-wide race to eliminate

paraTB.[324] The Netherlands, one of Europe's largest dairy exporters, has

pledged to eradicate paratuberculosis by the end of this year by

instigating a compulsory eradication program.[325] " To minimize the risk of

human exposure to paratuberculosis " is one of the explicit reasons given

for the Dutch program.[326] Sweden seems to be closest to winning the

battle, probably because it was the first country whose control efforts

were non-voluntary.[327] Australia is currently also certifying herds with

a view to eradication.[328] Although there are currently no restrictions on

international trade as a result of the disease,[329] that may well change

and potentially threaten America's $700 million dairy product export

industry.[330]

Mike began his messages to both the e's Disease Committee and

the general session of the US Animal Health Association with the same words

" Don't shoot the messenger. " [331] Rather than participating in serious

dialogue around the issue, the dairy industry has been accused of spending

its energies slinging mud at researchers in the field,[332] giving lip

service and vainly hoping it just all blows away.[333] Rossiter,

senior extension veterinarian with the Cornell University Veterinary

Diagnostic Laboratory, told the Wisconsin Agriculturist that those who

decide to address the issue are put at risk and there's " no value placed by

the industry on a person who wants to do something about e's. Nobody

wants to take it on. " [334]

At an international colloquium on paratuberculosis, Chiodini expressed his

view that the current focus of the American dairy industry " could put the

industry in the same light as the tobacco industry, being accused of a

cover-up and faced with all sorts of liabilities. " [335] Strandberg,

Assistant Attorney General of the State of Minnesota warned the e's

Committee that if they chose to be less than forthright about the possible

link between milk and beef and Crohn's Disease, they could wind up on " 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, the consumer movement needs to get a study of retail milk supplies in

the US funded. That is the recommendation of the Paratuberculosis Awareness

and Research Association.[337] That is the recommendation of researchers in

the field.[338] Not only has industry allegedly " totally ignored " this

approach,[339] one observer wrote that it would be " political suicide " for

a researcher in the US to even suggest such a thing.[340] However, there

have been two brave souls. Year after year, Chiodini and Hermon-,

world recognized authorities on MAP on Crohn's, have submitted proposals to

the USDA and to the FDA to test retail milk supplies, and year after year

their proposals have been rejected.[341]

At a meeting of the US Animal Health Association, a resolution was debated

on whether or not to recommend that the USDA test retail dairy products in

the United States for the presence of live paraTB bacteria. , the

National Milk Producers Federation executive member of the e's Disease

Working Group, was quite vocal in his opposition: " The FDA has already

stated their position. They are confident that pasteurized milk is safe. We

don't need to test retail milk. " [342]

Steve Merkel, a founding member of the Paratuberculosis Awareness and

Research Association and whose wife has suffered with Crohn's disease since

1960,[343] replied " With all due respect, sir, if milk is as safe as you

say it is, then retail testing will simply confirm that fact. Are you

afraid of retail milk testing because you are afraid of what you might

find? " The resolution was voted down by an overwhelming majority.[344]

The Paratuberculosis Awareness and Research Association kept at it.

Finally, in 1999, PARA successfully submitted two resolutions to the

e's Disease Committee, one recommending the testing of retail milk and

milk products for the presence of live MAP and another recommending

research to determine what cooking temperatures are needed to reliably kill

MAP in ground beef. Although both resolutions passed unanimously in open

committee, they were later voted down behind closed doors. PARA saw this as

the USAHA going on record as deliberately choosing ignorance about the

presence of MAP in food products for human consumption.[345]

The United States Animal Health Association tried to justify why the

resolutions were quashed: " During the discussions of these resolutions,

there was much concern about the feasibility of end-product testing of milk

and meat for an organism that science has not confirmed as being the cause

of Crohn's in humans, and the usage of this information. " In the opinion of

PARA, as expressed in a letter to Animal Health Association

President-elect, " this statement presents USAHA as not only primarily

self-serving, but further, is blatantly contemptuous of both its own member

producers and the American public. " The letter concludes " We at PARA are

saddened that USAHA has chosen to be part of 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

Britain, when asked what the industry planned to do about paratuberculosis,

spokespersons said that it was " something that bears watching " [347] but

that they " preferred to defer action " until paraTB is proven to cause

disease in humans.[348] This sounded all too familiar to the British public

after the mad cow debacle, where the beef industry made the same wager--and

lost.[349] According to some social science studies, it was the British

public authorities' decade-long insistence on the safety of beef that did

the most damage to the public trust.[350]

The American dairy industry is similarly gambling not only with the health

of consumers, but with their own financial health. The financial impact of

paraTB is enormous;[351] paratuberculosis currently costs the American

livestock industry over a billion dollars a year.[352] A 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 argues, " then the industries have taken the appropriate position

of 'lip-service,' to give an image of concern. " [353] If, however,--as PARA

phrased it in an open letter to the industry-- " dairy products become

associated with the dreadful, life-destroying disease known as Crohn's

disease, your markets may also collapse and may never recover. The image of

dairy foods as being necessary for good nutrition, carefully propagated and

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.

One third of cheese produced in the US is made from raw unpasteurized milk,

in which one could expect the highest levels of paraTB bacteria.[355]

Cheese manufacturers rely on the salty acidic environment of cheese to

inhibit bacterial growth,[356] but MAP is resistant to such

conditions.[357] Even less robust mycobacteria can survive in soft cheese

for at least 3 months and in hard cheese for up to 10 months.[358]

Reportedly, at the University of Wisconsin, there is currently a research

project which is investigating the survival of Mycobacterium

paratuberculosis in cheese.[359]

Since MAP can survive freezing for at least a year,[360] products such as

ice cream may also be implicated.[361] Ice cream may also come from less

rigorously pasteurized milk.[362] Other 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 e's

is to have her sent to slaughter. Beef from e's cattle is not prevented

from being sold for human consumption because paratuberculosis is not

officially considered a human pathogen. End-stage animals, their bodies

dripping with literally trillions of paratuberculosis bacteria, are ground

straight into hamburger meat.[364] When Crohn's patient advocates found out

that infected tissue from animals with severe clinical paratuberculosis

were funneled into the human food supply they were described as, not

surprisingly, " abhorred and nauseated. " [365]

In the advanced stages of e's Disease, MAP bacteria course through the

cow's blood stream, infecting her internal organs, and potentially her

muscle tissue. Even if the muscle tissue didn't contain large numbers of

MAP before the infected cow's death, when she's slaughtered it seems

impossible to ensure that 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 scientist put it: " Consequently, both

preharvest and postharvest contamination of food products originating from

cattle is plausible. " [367]

Although Americans eat 2.6 billion pounds of culled dairy cows annually,

most hamburger meat comes from cattle raised for beef. In 1984, about one

percent of US beef cattle were found positive for e's Disease. Research

is ongoing at the USDA to determine the current prevalence of e's

Disease in beef cattle, but since e's is such a hidden disease, is not

reportable, and is not the subject of a mandatory control program, one

might suspect that the incidence has increased significantly as it has in

the dairy cattle population.[368] In spite of this situation, lack of

awareness among beef producers is even greater than in dairy producers. The

USDA Center for Animal Health Monitoring reports that 69.8% of US beef

producers " had not heard of it [e's] before. " And less then 10% of

producers had any knowledge beyond name recognition.[369]

MAP bacteria probably survive standard cooking temperatures. Mycobacterium

paratuberculosis is the most heat resistant mycobacterium present in retail

beef.[370] Even well cooked meat may contain live paraTB. The USDA

recommends that hamburgers be cooked to 71o Celsius (160o F). An unpierced

roast or steak need only reach an internal temp of 63o C (145o F). Studies

show prolonged exposure to at least 74o (165o F) may be necessary to

eliminate the paratuberculosis bug.[371] Mycobacterium paratuberculosis is

also resistant to nitrites and the smoking process used in sausage

production.[372] MAP may contaminate other meats as well--paratuberculosis

is suspected in pigs and chickens.[373]

Milk may be more dangerous to consume than meat, though, in regards to

paratuberculosis. MAP is thought to survive digestion when carried in a

vehicle like milk, because--as designed by nature--milk buffers the stomach

environment to a near-neutral pH. In meat however, MAP's ability to survive

digestion by stomach acid is less certain.

Water

Municipal water supplies must also be assessed for risk because surface

waters contaminated by agricultural run-off feed the domestic water

supplies of many communities in the US.[374] One of the reasons why paraTB

has been called a " superbug " is because of its ability to survive in the

environment for prolonged periods.[375] Mycobacteria like paraTB have

survived on this planet for over a billion years which has allowed them to

adapt.[376] In the environment, MAP has a thick waxy cell wall which

protects it[377]--it can last for 9 months in mud,[378] and almost year in

manure[379] and two 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 of MAP bacteria cultured

from drinking water, both in Europe[382] and from the water supply of a

major American city.[383] Europe's Drinking Water Inspectorate has

commissioned a study into the distribution and fate of MAP in drinking

water treatment;[384] the same inquiry should be happening here.

2000

The development last year with the most serious ramifications was published

in the April 2000 issue of the American Journal of Gastroenterology.

Knowing that cows with e'sdisease shed paratuberculosis into their

breast milk, researchers wondered whether paratuberculosis bacteria could

be detected in the milk of human mothers with Crohn's disease. Researchers

also knew that there were reports of mothers with other mycobacterial

diseases like leprosy shedding bacteria into their milk. So they examined

two mothers with Crohn's who had just given birth and found

paratuberculosis bacteria growing in both the mothers' breast milk, but not

in the breast milk from control mothers without Crohn's. While breast

feeding has not been found to be a risk factor for Crohn's and may actually

have a protective effect,[385] the presence of MAP in the breast milk of

mothers with Crohn's not only adds support to the role of MAP in the

pathogenesis of Crohn's disease,[386] but 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

continues to be tolerated in our food supply.[388] After finding of MAP in

their retail milk supply, the Food Safety Authority of Ireland now requires

that cattle infected with e's be excluded from the food supply. The

flesh from an infected cow is no longer considered fit for human

consumption and her milk is simply dumped.[389] Meyer of PARA

commented, " The government of Ireland is to be commended for exercising the

precautionary principle. Instead of trying to sweep the problem under the

rug, they acted swiftly to give human health priority over special

interests. " [390]

The paratuberculosis problem in Ireland is minimal compared to that of the

United States. According to the Chief Executive of the Food Safety

Authority, of the 7.6 million cattle in Ireland, there are only 12 reported

cases of e's disease. Nineteen percent of Irish retail milk samples

grew out live paraTB and researchers only found12 cases of e's disease

in the entire country. Obviously, as the Food Safety Authority concedes,

this may be an underestimate, but in the United States the paratuberculosis

problem is exponentially worse. The estimated prevalence in the US is some

20,000 times greater than that of Ireland.[391]

If any country should be preventing contamination of the human food supply

it should be the United States, which has the highest prevalence of e's

disease in the world.[392] At their Fall 2000 meeting, however, the

National e's Working Group continued to propose only voluntary measures

to protect cattle health and no measures to protect human health.[393] The

removal of clinically infected animals from the human food supply alone has

been modeled as having a highly significant impact.[394] This could

evidently be accomplished with relative ease, but as yet there has been

little effort to do so.[395] When asked how long it would take to clean up

America's herds if suddenly no milk from e's-positive cows could be

sold, one e's Disease Committee member said " About six months. " [396]

The consumer movement also needs to fight to make Crohn's a reportable

illness.[397] The official FDA stance that pasteurization eliminates MAP is

no longer tenable and must be continuously confronted with the British

retail milk studies which put an end to the pasteurization debate once and

for all. An extensive Freedom of Information Act search must be initiated

to unearth suppressed documents. For example, seven years ago Canada's

agriculture department produced a food safety risk assessment paper

concluding that the paraTB-Crohn's link was something about which to be

concerned. The document, however, was stamped " Protected. Not for

Distribution " and was as such buried.[398] These are the kinds of documents

the consumer movement needs to get a hold of.

In Dr. Hermon-'s view, " There is overwhelming evidence that we are

sitting on a public health disaster of tragic proportions. " [399] Europe's

Scientific Committee on Animal Health and Animal Welfare, however,

concluded that the currently available evidence was insufficient to confirm

or disprove the theory.[400] This uncertainly should not impede the

government from taking concrete steps to prevent further potential human

catastrophe. If the British government had acknowledged the precautionary

principle, millions of lives may have been saved. A headline in The Times

sums up an inquiry into the mishandling of the mad cow affair released last

year in Britain: " Lack of Proof Led to Disaster. " [401]

The precautionary principal is the basis for most European environmental

law and is playing an increasingly important role in health policies

worldwide.[402] Basically it states " If one has a reasonable suspicion that

something bad might be going to happen, one has an obligation to try to

stop it. " [403] An 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

that people who want to reduce their risk of infection or

reinfection--especially those with Crohn's disease, or their close

relatives (who might be genetically pre-disposed)--should stop eating dairy

products unless they are effectively boiled first.[404] PARA recommends

that cheese should be heated to the temperature of boiling water, 100o C

(212o F), to reduce the threat. Thus, grilling cheese under direct heat for

a few minutes (so that it " bubbles " ), or cooking it in oven-baked meals,

such as oven-baked lasagna, should effectively sterilize the cheese. The

same 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 safe, is because it could affect the taste of the milk. As the Irish

Food Safety Authority put it, " there is an upper temperature beyond which

unacceptable changes to the taste of milk start to occur. " [406] Steve

Merkel of PARA would have governments mandate raising the minimum

pasteurization temperature to levels that ensured safety regardless, " even

if it means that milk doesn't taste the same as it did. Human health must

take precedence over taste. " [407]

Stricter pasteurization may not be the answer, though. Although there is

recent evidence that living MAP bacteria cause Crohn's,[408] even dead MAP

may be able to trigger disease.[409] For example, one of the reasons that

the vaccine for e's is so seldom used is because it is so dangerous to

handle.[410] Even though the vaccine is made out of killed MAP bacteria,

the human immune system can react so violently just to the presence of MAP

proteins, that accidentally injected into humans (or purposefully into

other primates), the MAP vaccine causes a chronic progressive inflammation

which can last for years[411] or may even necessitate amputation of the

injection site.[412] Closely related bugs like leprosy can have similar

effects.[4133] So even if MAP is pasteurized to death, drinking the

remnants of the bacteria may still cause a problem.

With this in mind, it may be more prudent to avoid dairy altogether.

Although ingesting relatively few organisms may be able to cause infection,

the human infective dose is not known.[414] It is also not known how

heavily the milk supply is contaminated in this country. The most esteemed

pediatrician of all time, Dr. Spock, advised that children be

raised vegan, with zero exposure to dairy products for a variety of

reasons.[415] Especially considering the risk of paratuberculosis in milk,

this would seem sensible advice, particularly for children and

adolescents.[416] There is a wide variety of dairy product substitutes--soy

and rice milks, cheeses, ice cream, yogurt, etc.--making animal derived

dairy products unnecessary.

Conclusion

The epidemic of e's disease, like that of mad cow disease, is an

indictment of factory farming.[417] Intensive confinement systems in animal

agriculture have been accused of not only threatening the global

environment, but public health as well.[418] The unnatural concentration of

animals raised for slaughter, for example, has led to other human tragedies

including the single worst epidemic in recorded world history, the 1918

influenza pandemic.[419] In that case, the unnatural density and proximity

of pigs and ducks raised for slaughter led to the deaths of upwards of 40

millionpeople.[420]

This potential crisis is also an indictment of an industry that continues

to risk public safety and a government that seems to protect business

interests over those of the consumer. As Meyer recently told the LA

Times, " 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

disease and may be condemned to a life of chronic suffering.[422] The

balance of evidence strongly suggests a causative link between

Mycobacterium paratuberculosis and Crohn's disease.423 This public health

issue has been at the periphery of the dairy industry's agenda for years, a

nagging concern on the back burner.[424] The consumer movement needs to

move it to the front burner and needs to turn up the heat.

------------------------------------------------------------------------

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[2] Centers for Disease Control and Prevention. " CDC Surveillance

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[3] Stark, C. " Turkey Safety Information from USDA. " Cornell ative

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[5] McDowell, RM and MD McElvaine. " Long-Term Sequelae To Foodborne

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[22] Scientific Committee on Animal Health and Animal Welfare. Possible

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[31] Chiodini RJ. " Mycobacterium paratuberculosis. " Second International

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[32] Chiodini RJ. " Historical Overview and Current Approaches in

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GNJ (eds): Is Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer

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[33] Dalziel TK. " Chronic Interstitial Enteritis. " British Medical Journal

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[36] Chiodini RJ. " Historical Overview and Current Approaches in

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[37] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

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[38] " Infective Agents - Mycobacteria. " Inflammatory Bowel Disease

1997:-131.

[39] NAID. " Crohn's Disease - Is There a Microbial Etiology?

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[40] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call for

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[41] Andus T, et al. " Etiology and Pathophysiology of Inflammatory Bowel

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[42] Chiodini RJ and CA Rossiter. " Paratuberculosis: A Potential Zoonosis? "

Veterinary Clinics of North America 12(1996):457-67.

[43] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[44] Chiodini RJ. " Historical Overview and Current Approaches in

Determining a Mycobacterial Etiology of Crohn's Disease. " Mulder and Tytgat

GNJ (eds): Is Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer

Academic Publishers, 1992, pp 1-15.

[45] DE. " The Role of Mycobacteria in Crohn's Disease. " Journal of

Medical Microbiology 41(1994):74-94.

[46] Chiodini RJ. " Historical Overview and Current Approaches in

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GNJ (eds): Is Crohn's Disease a Mycobacterial Disease? Dordrecht: Kluwer

Academic Publishers, 1992, pp 1-15.

[47] Hermon-, J. " The Causation of Crohn's Disease and Treatment with

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[48] El-Zaatari and DY Graham. " Mycobacterial Etiology of Crohn's Disease. "

Is Crohn's Disease a Mycobacterial Disease? CJJ Mulder and GNJ Tytgat (Ed.)

Dordrecht, The Netherlands: Kluwer Academic Publishers, 1992.

[49] Chiodini RJ and CA Rossiter. " Paratuberculosis: A Potential Zoonosis? "

Veterinary Clinics of North America 12(1996):457-67.

[50] Ibid.

[51] NAID. " Crohn's Disease - Is There a Microbial Etiology?

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[138] Hornick DB. " Nontuberculous Mycobacterial Lung Disease. " Chest

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[139] Chiodini, RJ. " Antimicrobial Agents and Crohn's Disease: Do they have

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[140] DE. " The Role of Mycobacteria in Crohn's Disease. " Journal

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[142] Hulten K. " Antibacterial Therapy for Crohn's Disease: A Review

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[143] Scientific Committee on Animal Health and Animal Welfare. Possible

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[144] Ibid.

[145] Gui, GPH, et al. " Two-year Outcomes Analysis of Crohn's Disease

Treated with Rifabutin and Macrolide Antibiotics. " Journal of Antimicrobial

Chemotherapy 1997 Mar;39(3):393-400.

[146] Ibid.

[147] Scientific Committee on Animal Health and Animal Welfare. Possible

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[148] Gui, GPH, et al. " Two-year Outcomes Analysis of Crohn's Disease

Treated with Rifabutin and Macrolide Antibiotics. " Journal of Antimicrobial

Chemotherapy 1997 Mar;39(3):393-400.

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[150] Gui, GPH, et al. " Two-year Outcomes Analysis of Crohn's Disease

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Chemotherapy 1997 Mar;39(3):393-400.

[151] Ibid.

[152] Brody, TJ, et al. " Treatment of Severe Crohn's Disease Using

Rifabutin-Macrolide-Clofazimine Combinations: Interim Report. " American

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[153] A. " An Open Pilot Study of Antimicrobial Therapy in Patients

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[154] Borody, TJ, et al. " Treatment of Severe Crohn's Disease(CD) Using

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46(2000):A1334.

[155] Cann, PA and MG Bramble. " An Open Pilot Study of Antimicrobial Agents

in the Management of Resistant Crohn's Disease. " Gut 46(2000):A1335.

[156] Shafran I, et al. " Rifabutin and Macrolide Antibiotic Treatment in

Crohn's Patients Identified Serologically Positive for Mycobacterium avium

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[157] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

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[185] " Some cases of Crohn's Disease appear to respond to antibiotic

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[161] Shafran, et al. " Endoscopic Healing of Crohn's After Antibiotic

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[162] Maugh, TH. " Plenty of Relief... and Skepticism. " Los Angeles Times 18

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

[164] This may be particularly important in that the subjects were also

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

[166] Ibid.

[167] Ibid.

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

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[174] Murray, I. " Crohn's Linked To Bacteria In Milk. " The Times (London)

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[175] El-Zaatari and DY Graham. " Mycobacterial Etiology of Crohn's

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[176] Lorber B. " Are All Diseases Infectious? " ls of Internal Medicine

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[177] Maugh II, TH. " Spreading a New Idea on Disease: Mounting Evidence May

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[178] " Helicobacter pylori in peptic ulcer Disease. " NIH Consensus

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

[180] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

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[181] Boyce, N. " Milk Theory Stirs Up Bowel Disease Experts. " New Scientist

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[182] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

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[184] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

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[186] , KL and JS Hogan. " Milk Quality - A Worldwide Perspective. "

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[187] Assuming a billion lymphocytes/ml as a reasonable defining

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regulations and food safety. Bulletin of the International Dairy Federation

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[189] Millar D, et al. " IS900 PCR to Detect Mycobacterium paratuberculosis

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[190] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

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[191] Scientific Committee on Animal Health and Animal Welfare. Possible

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[192] Sung N and MT . " Thermal Tolerance in Mycobacterium

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[193] Ibid.

[194] Sung N, Kaspar CW2, and MT . " Determination of D-values in

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[195] Lord McColl. " Crohn's Disease. " Debate in the House of Lords. 19 Jun

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[196] Grant IR, Ball HJ and MT Rowe. " Effect of higher pasteurization

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[197] United States Animal Health Association. " Report of the USAHA

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[198] Grant IR, Ball HJ2, and MT Rowe. " A novel staining technique for

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during pasteurization. " Proc. 5th Intl. Coll. Paratuberculosis: Chiodini

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[199] Rampton S and J Stauber " Mad Cow U.S.A.: Could the Nightmare Happen

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[200] NAID. " Crohn's Disease - Is There a Microbial Etiology?

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[201] Riemann HP and B Abbas. " Diagnosis and Control of Bovine

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[202] Paratuberculosis Awareness & Research Association. " MAP in the United

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[203] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

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[204] Ibid.

[205] Kennedy, A. " The Prevalence of BJD (Bovine e's Disease). "

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[206] Nunes GC and RE Ahlquist, Jr. " Increasing Incidence of Crohn's

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

[208] Proceedings of the 1999 Cornell Nutrition Conference for Feed

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[209] Ibid.

[210] Mohr, P. " Yanking e's chain: With management, testing and

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[211] Cocito C, et al. " Paratuberculosis. " Clinical Microbiology Reviews

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[212] Kennedy, A. " The Prevalence of BJD (Bovine e's Disease). "

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[213] " e's Disease--a Growing Threat to Dairymen. " Hoard's Dairyman 25

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[214] NAID. " Crohn's Disease - Is There a Microbial Etiology?

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[215] Crohn's & Colitis Foundation of America, Inc. " NIH Seeks Answers. "

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[216] Hermon-, J, et al. " Mycobacteria and the Aetiology of Crohn's

Disease. " Inflammatory Bowel Disease 1994.

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[217] Grant IR. " Does Mycobacterium paratuberculosis Survive Current

Pasteurization Conditions? " Applied and Environmental Microbiology

64(1988):2760.

[218] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

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[219] Grant IR. " Does Mycobacterium paratuberculosis Survive Current

Pasteurization Conditions? " Applied and Environmental Microbiology

64(1988):2760.

[220] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

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[221] Cerf O and MW Griffiths. " Mycobacterium paratuberculosis Heat

Resistance. " Letters in Applied Microbiology 30(2000):341-3.

[222] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

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[223] Stabel JR, Steadham EM and CA Boilin. " Heat Inactivation of

Mycobacterium paratuberculosis in Raw Milk: Are Current Pasteurization

Conditions Effective? " Applied and Environmental Microbiology

63(1997):4975-7.

[224] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaT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[225] Chamberlain, L. " Lactose Intolerant. " Cleveland Free Times June, 1999.

[226] Paratuberculosis Awareness & Research Association. " MAP in food: The

case for retail testing. " Presented to the Food Safety Committee of the

United States Animal Health Association in October 1998.

http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm.

[227] Paratuberculosis Awareness and Research Association. " World's

foremost research minds target Crohn's Disease. " January 4 1999.

http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm

[228] Ibid

[229] Grant IR, Ball HJ and MT Rowe. " Effect of high-temperature,

short-time (HTST) pasteurization on milk containing low numbers of

Mycobacterium paratuberculosis. "

[230] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

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[231] Rossiter CA and WS Burhans. " Farm-specific Approach to

Paratuberculosis (e's Disease) Control. " Veterinary Clinics of North

America 12(1996):383.

[232] Gutknecht, K. " A needling question: Does Pasteurization really kill

M. paratuberculosis? " Wisconsin Agriculturist July 1998

[233] May 10, 1998 issue per (Business Wire. " Anti-Milk Group Exposes Claim

That Normal Pasteurization Kills Dangerous Bacterium in Milk. " July 14,

1998.)

[234] O'Sullivan K. " Food Group Says Irish Milk is Safe. " The Irish Times

12 August 1998:3.

[235] Comerford C. " Milk in Link to Stomach Disease. " The Independent

(London) 11 August 1998:2.

[236] Hermon-, J. " The Causation of Crohn's Disease and Treatment

with Antimicrobial Drugs. " Italian Journal of Gastroenterology-Hepatology

1998 Dec;30(6):607-10.

[237] Whalley, S. " Milk Drinkers Cool Over Health Scare. " Business

Information August 14, 1998:8. www.reedbusiness.com/retail.htm

[238] Freeman, M. " Angry reaction to Crohn's Disease allegation. " Farmers

Guardian January 28, 2000:7.

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

[240] Lord Greenway. " Crohn's Disease. " Debate in the House of Lords. 19

Jun 2000. Column 82.

[241] Scientific Committee on Animal Health and Animal Welfare. Possible

links between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000

European Commission Directorate-General Health & Consumer Protection

Directorate B - Scientific Health Opinions Unit B3. Adopted 21 March

2000:50-51.

[242] Maugh, TH. " Milk May be the r of Crohn's. " Los Angeles Times 18

September 2000:S1.

[243] Hermon- J. " Mycobacterium Paratuberculosis as a Chronic Enteric

Pathogen in Humans. " Fourth International Colloquium on Paratuberculosis

Chiodini RJ, MT and EOE Bassey, eds. Cambridge, UK: International

Association for Paratuberculosis, 1994 :174-80.

[244] Brown D. " Milk Heat Treatment Increased. " The Daily Telegraph 12

August 1998.

[245] Lord Turnberg. " Crohn's Disease. " Debate in the House of Lords. 19

Jun 2000. Column 82.

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

Publishing, 1996.

[247] Stabel JR, Steadham EM and CA Boilin. " Heat Inactivation of

Mycobacterium paratuberculosis in Raw Milk: Are Current Pasteurization

Conditions Effective? " Applied and Environmental Microbiology

63(1997):4975-7.

[248] Westcott S. " Minister 'confident' Over Safety of Milk. " Press

Association Newsfile April 2, 2000, Sunday.

[249] Bleifuss, J. " A 21st Century Plague?; Britain's mad cows may

harbinger the deaths of millions. " In These Times 7 February 2000:2.

[250] Tribune News Service. " Pasteurized Milk 'Safe.' " Chicago Tribune 9

September 1996:3.

[251] Maugh, TH. " Milk May be the r of Crohn's. " Los Angeles Times 18

September 2000:S1.

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

[253] Paratuberculosis Awareness and Research Association. " FDA Claims Milk

Safe, Evades Farm Magazine Editor's Questions. "

http://www.crohns.org/media/pr200798.htm

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

the state.

[255] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[256] Mason O, Rowe MT and HJ Ball. " Is Mycobacterium paratuberculosis a

possible agent in Crohn's Disease? Implications for the Dairy Industry. "

Milk Science International 52(1997:311-6.

[257] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[258] Chiodini RJ and HJ van Kruiningen. " The Prevalence of

Paratuberculosis in Culled New England Cattle. " Cornell Veterinarian

76(1986):91-104.

[259] Riemann HP and B Abbas. " Diagnosis and Control of Bovine

Paratuberculosis (e's Disease). " Advances in Veterinary Science and

Comparative Medicine 27(1983):481-505.

[260] Stabel JR " e's Disease: A Hidden Threat. " Journal of Dairy

Science 81(1998):283-288.

[261] Proceedings of the 1999 Cornell Nutrition Conference for Feed

Manufacturers Ithaca, NY: Dept. of Animal Science, 1999:132.

[262] Scientific Committee on Animal Health and Animal Welfare. Possible

links between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000

European Commission Directorate-General Health & Consumer Protection

Directorate B - Scientific Health Opinions Unit B3. Adopted 21 March

2000:9.

[263] Ibid:21.

[264] DE. " The Role of Mycobacteria in Crohn's Disease. " Journal

of Medical Microbiology 41(1994):74-94.

[265] Whitlock RH and C Buergelt. " Preclinical and Clinical Manifestations

of Paratuberculosis (including Pathology). Veterinary Clinics of North

America 12(1996):345-55.

[266] Pell AN. " Manure and Microbes. " Journal of Dairy Science

80(1997):2673-81.

[276] Whitlock RH and C Buergelt. " Preclinical and Clinical Manifestations

of Paratuberculosis (including Pathology). Veterinary Clinics of North

America 12(1996):345-55.

[268] Crohn's & Colitis Foundation of America, Inc. " NIH Seeks Answers. "

December 30, 1998. www.ccfa.org/news/news1230.htm

[269] Hansen D and C Rossiter " Clinical description and epidemiology of

e's Disease in cattle. " National e's Working Group, a subcommittee

of the e's Committee of the U. S. Animal Health Association.

[270] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[271] Whitlock RH and C Buergelt. " Preclinical and Clinical Manifestations

of Paratuberculosis (including Pathology). Veterinary Clinics of North

America 12(1996):345-55.

[272] Scientific Committee on Animal Health and Animal Welfare. Possible

links between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000

European Commission Directorate-General Health & Consumer Protection

Directorate B - Scientific Health Opinions Unit B3. Adopted 21 March

2000:13.

[273] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[274] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[275] MT. " Diagnosis and Control of Paratuberculosis. " Fourth

International Colloquium on Paratuberculosis Chiodini RJ, MT and

EOE Bassey, eds. Cambridge, UK: International Association for

Paratuberculosis, 1994:325-44.

[276] s WD. " Environmental Acidity may be the Missing Piece in the

e's Disease Puzzle. " e's Disease Milner AR and PR Wood eds.

Australia: Csiro:99-103.

[277] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[278] Rossiter CA and WS Burhans. " Farm-specific Approach to

Paratuberculosis (e's Disease) Control. " Veterinary Clinics of North

America 12(1996):383.

[279] Proceedings of the 1999 Cornell Nutrition Conference for Feed

Manufacturers Ithaca, NY: Dept. of Animal Science, 1999:130.

[280] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[281] MT. " Diagnosis and Control of Paratuberculosis. " Fourth

International Colloquium on Paratuberculosis Chiodini RJ, MT and

EOE Bassey, eds. Cambridge, UK: International Association for

Paratuberculosis, 1994:325-44.

[282] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[283] Ibid.

[284] Highly esteemed Professor of Animal Science Temple Grandin describes

the practice in Oliver W. Sacks' An Anthropologist on Mars (1996): " That's

one sad, unhappy, upset cow. She wants her baby, hunting for it. It's like

grieving, mourning--not much written about it. people don't like to allow

them thoughts or feelings. "

[285] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[286] Mohr, P. " Yanking e's chain: With management, testing and

vaccinating, the Steins plan to get this Disease under control. " Dairy

Today November 1997.

[287] Arbuthnot A. " e's Disease: a Dairy Industry Perspective. " e's

Disease Milner AR and PR Wood eds. Australia: Csiro:99-103.

[288] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[289] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[290] Galloway, JA. " USDA Reviewing Milk Safety Standards; Bacteria-Disease

Link Examined. " Wisconsin State Journal February 1, 1995:1A.

[291] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[292] MT. Mycobacterium paratuberculosis: A Food-Borne Pathogen? "

Journal of Dairy Science 80(1997):3445-8.

[293] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[294] Mohr, P. " Yanking e's chain: With management, testing and

vaccinating, the Steins plan to get this Disease under control. " Dairy

Today November 1997.

[295] Ibid.

[296] Wells SJ, et al. " e's Disease on US Dairy Operations. "

Proceedings of the Fifth International Colloquium on Paratuberculosis

Chiodini RK, Hines ME, and MT (Eds.) Madison, WI: International

Association for Paratuberculosis, 1996:140-2.

[297] Paratuberculosis Awareness and Research Association. " PARA Executive

Director addresses e's Disease groups. " November 24 1999.

http://www.crohns.org/media/pr241199.htm'>http://www.crohns.org/media/pr241199.htm

[298] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[299] Ibid.

[300] Paratuberculosis Awareness and Research Association. " World's

foremost research minds target Crohn's Disease. " January 4 1999.

http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm

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

[302] s WD. " Environmental Acidity may be the Missing Piece in the

e's Disease Puzzle. " e's Disease Milner AR and PR Wood eds.

Australia: Csiro:99-103.

[303] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[304] Per (USDA: APHIS. " e's Disease on U.S. Dairy Operations. "

National Animal Health Monitoring System. October, 1997) an underestimate

of 3.4% all dairy cows infected. Per (Dargatz D, et al. " What Do I Need to

Know About e's Disease in Beef Cattle? " USDA:APHIS:VS.

http://www.aphis.usda.gov/vs/ceah/cahmN309.899 August 1999) .4% of all beef

cattle infected. Per (Institute of Medicine. The Use of Drugs in Food

Animals. Washington DC: National Academy Press, 1999)10 million dairy

cattle, 100 million beef cattle in the US.

[305] Rossiter CA and WS Burhans. " Farm-specific Approach to

Paratuberculosis (e's Disease) Control. " Veterinary Clinics of North

America 12(1996):383.

[306] Sweeney RW. " Transmission of Paratuberculosis. " Veterinary Clinics of

North America 12(1996):305-11.

[307] Wells SJ. " Herd-Level Risk Factors for Infection with Mycobacterium

paratuberculosis in US Dairies and Association between Familiarity of the

Herd Manager with the Disease or Prior Diagnosis of the Disease in that

Herd and Use of Preventive Measures. " Journal of the American Veterinary

Medical Association 216(2000):1450-7.

[308] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[309] Sockett DC. " e's Disease Eradication and Control. " Veterinary

Clinics of North America 12(1996):431-39.

[310] " Paratuberculosis Regulations Changed. " Journal of the American

Veterinary Medical Association 216(2000):1695.

[311] Sockett DC. " e's Disease Eradication and Control. " Veterinary

Clinics of North America 12(1996):431-39.

[321] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[313] Paratuberculosis Awareness and Research Association. " World's

foremost research minds target Crohn's Disease. " January 4 1999.

http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm

[314] Rampton, S and J Stauber. Mad Cow USA: Could the Nightmare Happen

Here. Monroe, ME: Common Courage Press, 1997.

[315] Sockett DC. " e's Disease Eradication and Control. " Veterinary

Clinics of North America 12(1996):431-39.

[316] Paratuberculosis Awareness and Research Association. " PARA Takes the

Case for Retail Testing to USAHA(U.S. Animal Health Association). "

http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm

[317] USDA: APHIS. " e's Disease on U.S. Dairy Operations. " National

Animal Health Monitoring System. October, 1997.

[318] Mohr, P. " Yanking e's chain: With management, testing and

vaccinating, the Steins plan to get this Disease under control. " Dairy

Today November 1997.

[319] Bulaga LL and MT . " U.S. Voluntary e's Disease Herd Status

Program for Cattle. " Proceedings of the Sixth International Colloquium on

Paratuberculosis: Manning EJB, MT(eds) International Association

for Paratuberculosis, 1999.

[320] Sockett DC. " e's Disease Eradication and Control. " Veterinary

Clinics of North America 12(1996):431-39.

[321] Ibid.

[322] Paratuberculosis Awareness Research Association. " Mycobacterium

paratuberculosis in retail beef supplies. "

http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm

[323] Newsing J. " The Roast Beef of Old England. " International Journal of

Health Services 27(1997):243-6.

[324] Paratuberculosis Awareness and Research Association. " PARA Executive

Director addresses e's Disease groups. " November 24 1999.

http://www.crohns.org/media/pr241199.htm'>http://www.crohns.org/media/pr241199.htm

[325] United States Animal Health Association. " Report of the USAHA

Committee on Food Safety. " Monday, October 5, 1998 in Minneapolis, Minn.

[326] Paratuberculosis Awareness and Research Association. " Experts from

around the world gather to discuss Paratuberculosis, e's Disease and

Crohn's Disease. " February 19 1999. http://www.crohns.org/media/colloq.htm

[327] Rossiter CA. " On-Farm Control of e's Disease in Cattle

Populations. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:132-9.

[328] Hoy, A. " Disease threat to a million sheep. " Sydney Morning Herald

July 30th 1997

[329] Mohr, P. " Yanking e's chain: With management, testing and

vaccinating, the Steins plan to get this Disease under control. " Dairy

Today November 1997.

[330] United States Animal Health Association. " Report of the USAHA

Committee on Food Safety. " Monday, October 5, 1998 in Minneapolis, Minn.

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

Publishing, 1996.

[332] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[333] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[334] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[335] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[336] Paratuberculosis Awareness and Research Association. " PARA Takes the

Case for Retail Testing to USAHA(U.S. Animal Health Association). "

http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm

[337] Paratuberculosis Awareness & Research Association. " MAP in food: The

case for retail testing. " Presented to the Food Safety Committee of the

United States Animal Health Association in October 1998.

http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm.

[338] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm

[339] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[340] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist. December 1997.

[341] Gutknecht, K. " A Needling Question: Does Pasteurization really kill

M. paratuberculosis? " Wisconsin Agriculturist July 1998

[342] Paratuberculosis Awareness and Research Association. " PARA Takes the

Case for Retail Testing to USAHA(U.S. Animal Health Association). "

http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm

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

[344] Paratuberculosis Awareness and Research Association. " PARA Takes the

Case for Retail Testing to USAHA(U.S. Animal Health Association). "

http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm'>http://www.crohns.org/media/pr151098.htm

[345] Ibid.

[346] Ibid.

[347] Paratuberculosis Awareness and Research Association. " World's

foremost research minds target Crohn's Disease. " January 4 1999.

http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm

[348] Kennedy, Alan. " Does Mycobacteria Cause Crohn's Disease? "

http://www.iol.ie/alank/CROHNS/welcome.htm

[349] Stuttaford, T. " Lack of Proof Led to Disaster. " The Times 26 October

2000:4.

[350] Jaboc M and T Hellstrom. " Policy Understanding of Science, Public

Trust and the BSE-CJD Crisis. " Journal of Hazardous Materials

78(2000):303-17.

[351] Cocito C, et al. " Paratuberculosis. " Clinical Microbiology Reviews

7(1994):328-45.

[352] Gutknecht, K. " Dire Warnings About e's Disease: A wake-up call

for the dairy industry? " Wisconsin Agriculturist December.

[353] Chiodini RJ. " M paratuberculosis in Foods and the Public Health

Implications. " Proceedings of the Fifth International Colloquium on

Paratuberculosis Chiodini RK, Hines ME, and MT (Eds.) Madison, WI:

International Association for Paratuberculosis, 1996:353-365.

[354] Paratuberculosis Awareness and Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm

[355] McDowell, RM and MD McElvaine. " Long-Term Sequelae To Foodborne

Disease. " Office of Risk Assessment and Animal and Plant Health inspection

Cost-Benefit Analysis. United States Department of Agriculture.

[356] Sung N1, Kaspar CW2, and MT . " Kinetics Of Nonthermal

Inactivation Of Mycobacterium paratuberculosis. " 5th Intl. Coll.

Paratuberculosis: Chiodini RJ, Hines IIME, MT (eds) Year1997.

[357] Ibid.

[358] Institute for Food Science and technology. " Mycobacterium

paratuberculosis and Milk. " Food Science and Technology Today

12(1998):223-7.

[359] Kennedy, A. " Why IBD sufferers should only consume UHT or Ultra

Pasteurized dairy products. " http://www.iol.ie/alank/CROHNS/uhtmilk.htm'>http://www.iol.ie/alank/CROHNS/uhtmilk.htm

[360] Larsen AB, et al. " Survival Time of Mycobacterium Paratuberculosis. "

American Journal of Veterinary Research July 1956:549-51.

[361] Chiodini RJ, et al. " Ruminant Paratuberculosis (e's Disease): The

Current Status and Future Prospects. " Cornell Veterinarian

74(1984):218-262.

[362] Paratuberculosis Awareness & Research Association. " MAP in food: The

case for retail testing. " Presented to the Food Safety Committee of the

United States Animal Health Association in October 1998.

http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm.

[363] Paratuberculosis Awareness Research Association. " Mycobacterium

Paratuberculosis In Retail Dairy Supplies. "

http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm'>http://members.aol.com/ParaTBweb/dairy.htm

[364] Paratuberculosis Awareness Research Association. " Mycobacterium

paratuberculosis in retail beef supplies. "

http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm

[365] Paratuberculosis Awareness and Research Association. " World's

foremost research minds target Crohn's Disease. " January 4 1999.

http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm'>http://www.crohns.org/media/pr040199.htm

[366] Paratuberculosis Awareness Research Association. " Mycobacterium

paratuberculosis in retail beef supplies. "

http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm

[367] MT. Mycobacterium paratuberculosis: A Food-Borne Pathogen? "

Journal of Dairy Science 80(1997):3445-8.

[368] Paratuberculosis Awareness Research Association. " Mycobacterium

paratuberculosis in retail beef supplies. "

http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm

[369] Dargatz DA, Wells SJ, and SL Ott. " e's Disease and U.S. Cow-calf

Operations. " Proc. 6th Intl. Coll. Paratuberculosis: Manning EJB,

MT(eds) 1999.

[370] Merkal RS and DL Whipple. " Inactivation of Mycobacterium bovis in

Meat products. " Applied and Environmental Microbiology 40(1980):282-4.

[371] Paratuberculosis Awareness Research Association. " Mycobacterium

paratuberculosis in retail beef supplies. "

http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm'>http://members.aol.com/ParaTBweb/beef.htm

[372] Merkal RS, JA Crawford and DL Whipple. " Heat Inactivation of

Mycobacterium avium-Mycobacterium intracellulare Complex Organisms in Meat

Products. " Applied and Environmental Microbiology 38(1979):831-5.

[373] Riemann HP and B Abbas. " Diagnosis and Control of Bovine

Paratuberculosis (e's Disease). " Advances in Veterinary Science and

Comparative Medicine 27(1983):481-505.

[374] NAID. " Crohn's Disease - Is There a Microbial Etiology?

Recommendations for a Research Agenda. " Conference was held in the Natcher

Conference Center on the NIH campus in Bethesda, land on December 14th,

1998.

[375] Scientific Committee on Animal Health and Animal Welfare. Possible

links between Crohn's Disease and Paratuberculosis. SANCO/B3/R16/2000

European Commission Directorate-General Health & Consumer Protection

Directorate B - Scientific Health Opinions Unit B3. Adopted 21 March

2000:51.

[376] Hermon-, J, et al. " Mycobacteria and the Aetiology of Crohn's

Disease. " Inflammatory Bowel Disease 1994.

http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm'>http://iol.ie/alank/CROHNS/paratub.htm.

[377] Paratuberculosis Awareness & Research Association. " MAP in food: The

case for retail testing. " Presented to the Food Safety Committee of the

United States Animal Health Association in October 1998.

http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm'>http://www.crohns.org/foodsafety/retail.htm.

[378] Riemann HP and B Abbas. " Diagnosis and Control of Bovine

Paratuberculosis (e's Disease). " Advances in Veterinary Science and

Comparative Medicine 27(1983):481-505.

[379] Institute for Food Science and technology. " Mycobacterium

paratuberculosis and Milk. " Food Science and Technology Today

12(1998):223-7.

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