Raw Milk Safety: An Apology and a Search for Common Ground

Several weeks ago, Dr. Billauer wrote a piece on her concerns over raw milk. An ACSH reader and her colleague, both trained in risk assessment, disagreed, and we posted their rebuttal on the website yesterday. Today, your news feeds may be filled with the unfortunate death in New Mexico of an infant, attributed to her mother drinking raw milk. As we often say, association is not causation, and the true cause of the infant’s death is not known and may never be known. However, I wanted to take this opportunity to chime in on raw milk, as both a physician and the “editor” of both articles. 

Peg Coleman and Dr. North are correct in stating that Dr. Billauer did not fully back up some of her statements with citations, and her understanding may be a little out of date. Neither of us is, nor claims to be, an expert in raw milk, so “our bad.” On the other hand, the Coleman North article has nuanced ambiguities that, as an editor, I felt were less important to our readership interested in the controversy around raw milk. Too long, didn’t read (TLDR) is a challenge in today’s media environment. 

Coleman and North are correct in pointing out that pasteurized milk contains modified proteins from the pasteurization process, which may trigger allergies in some, including me. In most instances, those allergies are outgrown. However, in citing the litany of raw milk’s benefits, they fail to say, as some of their citations write, that whether the benefit accrues simply from drinking raw milk or is, in part, from living in a rural environment where one is exposed to many more different antigens than in an urban setting is unclear. Another difficulty, shared by both articles, is that the real number of individuals consuming raw milk is unknown. In my fact-checking, I found this article suggesting that 4% of the nationally surveyed population drinks raw milk throughout the year. The number of deaths and hospitalizations from raw milk is low, but when reporting on the risk, knowing the number of consumers (the denominator in calculations) is critical. Coleman and North’s reporting of incidents of raw milk’s adverse effects by serving is a proxy and may underestimate the hazard to raw milk consumers.

Finally, the same report from the 2016 and 2019 Food Safety Survey notes that fully a quarter of raw milk consumers are drinking raw milk from unlicensed, unregulated farms. As a physician, I would argue that one of the confounders of raw milk is the chain of custody – knowing raw milk’s source and handling. There is no doubt that raw milk is biologically more fragile than pasteurized milk, so its handling is important. I do not doubt that the large commercial producers, as Coleman and North cited, are quite careful in the care of their cows and the handling of their milk. But there is no guarantee that all suppliers exercise this same level of care. Forgive the analogy, but when you purchase your drugs illicitly, you run a far greater risk of death from contaminants than if you pick up a prescription at CVS. 

Perhaps the middle way with respect to raw milk is to require governmental oversight for commercial sale to create a trustworthy chain of custody while creating barriers to unregulated commercial transactions. Of course, I would be remiss in not pointing out that for our most vulnerable, the newborns, cow’s milk isn’t even a contender to human breast milk or formula.