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You know how every summer has a theme? So, in 2019, Megan Thee Stallion gave us Hot Girl Summer.

Uh-huh, and a couple years later, we had Brat Summer.

Well, unfortunately, this year...

Hello and welcome to Planet Money.

It's Diarrhea Summer!

Womp womp. There is a parasite out there called Cyclospora. It's infected more than 1,600 people so far, with thousands more suspected cases. This parasite, it can cause explosive diarrhea. And, we're so sorry to have to say this, to the best of our knowledge, it is mostly spread by poop. Specifically, human poop.

Investigators are still trying to figure out where this came from. A lot of the people who got sick apparently ate at Taco Bell. And last week, the FDA announced that they traced the outbreak potentially to a bunch of shredded lettuce. lettuce from a company called Taylor Farms.

And Taylor Farms is very interesting because this company kind of came out of nowhere about 30 years ago and suddenly turned into the leading salad supplier in America. It's a multi-billion dollar operation that supplies not just Taco Bell, but also McDonald's and almost every store you've ever shopped in, from Costco to Whole Foods to Aldi to Safeway.

And now Taylor Farms is issuing a recall in 27 states for lettuce that could have been contaminated.

And we at Planet Money, we have noticed that this outbreak is revealing two very strange and fascinating systems that both have had a huge impact on how safe our food is. Both of these systems have gone through massive revolutions in recent decades. One of them is the incredibly large-scale and lucrative lettuce industry, and the other is the complicated regulatory system that is supposed to stop these outbreaks.

So we called up two people who were each intimately involved in those revolutions. Jim Gorney helped write the very first FDA rules to prevent germs from spreading on fruit and vegetable farms.

Let's see. Tell us, what did you have for breakfast today?

I had some just delicious Taco Bell breakfast this morning. It was very nice. I really very much enjoyed it.

And we also talked to Joe Pizzini. He was the director of agriculture for Taylor Farms. And he was part of the revolution that turned the lettuce industry into big lettuce.

Maybe not as big as potatoes.

Yeah, OK, potatoes are number one when it comes to fresh vegetables in the U.S., but the number two is actually lettuce. It is wild how much lettuce we eat. More than 25 pounds per person per year. That's more than tomatoes, more than onions, carrots, bell peppers.

So it's a big deal. Literally billions of servings a year.

Yeah. Over the years, the lettuce industry has become an economic juggernaut. And it is in part because of how big the industry has grown that lettuce can also be a big pain in the, you know.

Today on the show, two revolutions. The rise of big lettuce and the fight to make sure all our fresh vegetables are safe to eat.

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So as public health officials have been trying to uncover the source of this cyclospora parasite, they're having to look into all the stops along the path of a head of lettuce, from the restaurants and stores where it's served, to the processing facilities where it's chopped and bagged, and all the way back to the farms where it's grown.

And to understand what's happening now, you have to understand just how kind of miraculous this supply chain is. You see, there are really two pivotal moments in the history of lettuce that changed how we eat vegetables, changed how we buy vegetables, and also changed how risky our vegetables are.

And Joe Pazzini and his family of farmers were there for all of it.

Can you just list for us all the different types of vegetables that you've farmed in your life?

Wow. I guess I should start with A in artichokes, broccoli, cauliflower, celery, all the lettuces and leafy greens.

Joe is a third-generation farmer from the Salinas Valley, the salad bowl of the world.

I always compare it to...

being like a really big garden. This really big garden, a strip of farms running 90 miles through the middle of California, produces a huge portion of the fresh produce we eat in the United States.

So if you look at the Salinas Valley, it's a patchwork of color of different crops that are being grown all across the valley. And it's always changing. And it basically all revolves around

lettuce. How big of a deal is lettuce to the farmers in California to grow it? Well, in this area, it means everything, lettuce. Now, lettuce didn't used to be a big deal in Salinas. It didn't used to be a big deal in the United States even. But it became a big deal because of one big advantage lettuce has over all the other vegetables. It's crunchy. A head of iceberg lettuce can stay crisp for a pretty long time. Back in the 1900s, some farmers in California

realized iceberg lettuce could even survive a train ride to the hungry cities on the East Coast, all while keeping its signature crunch. This was even before the rise of refrigeration, which you can check out our Planet Money episode on that. In the old days, they would actually pack

lettuce in crates and throw ice on top of those crates and put it in a rail car and send it back

east, it lent itself to transportation. Pretty soon, lettuce became the first fresh vegetable to be available all over the place year round because you could grow it in California from spring to fall and then places like Arizona in the winter. The head of lettuce became the vanguard.

Yeah, lettuce was the first vegetable to defy the seasons. And that's how, by the 1950s, lettuce beat out cabbage to become America's number two fresh vegetable. And at first,

Customers were buying whole heads of lettuce in their local grocery stores, but the lettuce industry, and it was really an industry at this point, they kept trying to come up with ways of getting fresher and fresher produce to the East Coast.

And so they began experimenting with trying to influence the air around the lettuce, maybe by using a nitrogen flush or something like this, so that it would slow down the respiration rate so that lettuce would stay fresher. And it started with taking bins of lettuce and putting them in a big plastic bag.

And they realized that lettuce could keep a lot longer if you kept it in a carefully controlled environment with just the right mix of gases.

That led to, well, if you could do it on a big bin, why couldn't you do it in a bag? And so the big breakthrough was breathable film, and it would balance the oxygen and the CO2 levels. And so it would actually keep the lettuce fresh in this bag.

By the 1980s, this technology had gotten so good that you could even keep that lettuce fresh long after you had chopped it.

And once these breathable films were perfected, it was the advent of the bag salad business.

So the bags that are bagged salad come in, you're saying like that is a salad miracle, those bags that we see on the shelf.

Yeah, it's a little mini environment for that produce.

It is hard to understate what a huge breakthrough this special, breathable bag technology was. Because now, all of a sudden, lettuce growers could send chopped lettuce all around the country. By the 1990s, bagged salads were taking over our grocery stores.

And this bagged lettuce revolution completely changed the economics of America's favorite leafy green. A head of lettuce was a commodity. The price was determined by whoever could sell it for the cheapest. But a bag of lettuce, that was a manufactured product. Companies were chopping it up, mixing it with other vegetables, putting it in salad kits, and charging us a lot more money for those ready-made salads. This is the beginning of value-added products in the fresh produce industry.

But these value-add bagged salads weren't simple to produce. To make the economics work, you needed a huge expensive factory, tons of capital. Not everybody could do it.

So that is why these days there are basically only three salad processors that dominate the entire market for fresh chopped veggies. The biggest one is Taylor Farms. It was started in 1995 by Bruce Taylor, a third-generation lettuce producer, and he began by supplying bagged salad to restaurants, especially to fast food companies like McDonald's.

Pre-chopped bagged lettuce was a game-changer for those restaurants. Saved them so much time, and it made Taylor Farms a lot of money. Pretty soon, Taylor Farms was expanding into bagged salads at the grocery store. And by the time Jim went to work for them, Taylor Farms had become the largest salad processor in the country.

The idea that you could go to the grocery store and find consistent products every week of the year.

That's become the norm.

To me, it's almost like lettuce has become kind of a widget. I know exactly what that lettuce is going to look like. I know exactly what it's going to taste like. And I know it's going to be the same every time.

That's exactly where the business has evolved to.

And here is how that business works. Taylor Farms is a processor. They're like the middlemen. They buy lettuce from farmers, mostly in California and Arizona, but also in Mexico now. And they also grow some of their own lettuce. All that lettuce goes to one of more than two dozen processing facilities all over the country, where it gets washed, sometimes mixed up with other salad stuff, bagged up and sent around to restaurants and stores.

But as bagged salad and pre-cut broccoli and baby carrots and all these other value-added products begin to explode, so do our stomachs.

Yeah. As bag salad was taking over the world, we also started to see the rise of more and more foodborne illnesses, outbreaks like the one that's been all over the news this summer, some bacteria or parasite hiding out in the leafy greens and making people sick. And Joe says staying on top of this stuff, that was a huge part of his job because, you know, it is in Taylor Farms' interest to keep its customers from getting sick.

It was paramount in everything that we did on the farm. Really? So the water testing of the irrigation water, all the practices, we had a food safety department, and it was intense. It was important. It was part of everything that we did every day.

And actually, our food scientist, Jim Gorney, he says when these big outbreaks first started to occur, they kind of took the experts by surprise.

In the 1970s, there was a very low rate of illnesses associated with fresh produce. But in the 1990s, those rates doubled and the outbreaks kept getting bigger.

Now, one reason is that scientists were just getting way better at detecting these outbreaks, seeing the connections between symptoms that were popping up in multiple different states.

But also, Jim says the vast industrial way that we grow and process food was creating new risks, especially with bagged salad, where vegetables from all different farms are getting mixed together and then sent all over.

One mistake can be amplified up quite a bit as it goes through the processing plant, the packing house, as it gets co-mingled with other produce. So it makes the problem much worse. It's a multiplier effect.

So an outbreak that in the past might have been limited to one town or state can now spread across the entire country.

Now, at the time, in the 90s, Jim was a young food scientist. He was getting his Ph.D. while he was watching the growth of all these outbreaks. But pretty soon, he would be at the center of this massive effort to try to fix the problem, to completely overhaul how we deal with food safety.

But what it took to make that happen was one of the worst outbreaks of foodborne illness in U.S. history. It happened in 2006. People started showing up at a hospital with severe kidney failure. They had all apparently eaten from bags of baby spinach. More than 100 people were hospitalized. A few people even died.

And this spinach incident changed everything. It exposed a huge blind spot in how the government regulates our food supply.

Yeah, you see, in the U.S., there are basically two agencies in charge of making sure our food is safe to eat. There's the Department of Agriculture, which inspects meat and poultry. But for nearly everything else that we eat, that is the responsibility of the Food and Drug Administration, the FDA, where Jim would eventually go to work.

We like to say, I put the F in FDA, so.

Yes, Jim says the FDA isn't just about drugs, it's about food.

About 80% of the food supply is actually regulated by the U.S. Food and Drug Administration.

This F part of the FDA, it employs an army of food safety inspectors. They go into the facilities that bottle our milk, that bake our Oreos, that churn our ice cream. They make sure that the surfaces are clean, that workers are wearing hairnets, that everybody is following the food safety rules.

And at the time of the big spinach outbreak in 2006, there were safety rules for the facilities that were cleaning, chopping up, and bagging the salads. But there were no official FDA safety rules for the farms where all those vegetables came from.

Yeah, the farms growing the nation's fruits and vegetables, they were basically unregulated. Workers didn't even have to wash their hands. The FDA didn't have the legal power to tell them what to do.

Instead, it would wait for one of the outbreaks, and then the FDA would come in and investigate what went wrong. In this case, investigators were eventually able to trace the E. coli to a specific spinach field on a specific farm east of Salinas. But by that point, it was too late. One of the people that died was just a child.

His name was Kyle Allgood. He was a toddler, and he died of hemolytic... I'm litigating.

syndrome, which is basically where your kidneys shut down. It's a very painful way to die. And this poor child went through that, and that really affected me.

Jim says that incident made a lot of people realize that the FDA needs to be paying much closer attention to what is happening on farms. There were congressional hearings about

this. Can the FDA assure the safety and security of the nation's food supply?

And after much debate, in 2010, Congress passes the Food Security Modernization Act. And it was the biggest, most dramatic thing to happen to the FDA in nearly a century.

So this was a huge deal. I mean, this was a major overhaul. And it really was supposed to be the great leap forward for food safety and enhancing food safety across all commodities and all foods.

This new law, it basically supercharged the FDA. It gave it a bunch of new powers, including the power to finally send inspectors onto farms to make sure that the farmers are following the rules when it comes to food safety.

But before the FDA could start enforcing the rules, it actually had to write those rules. And this is where Jim enters the picture. In the late 2000s, he was working at the University of California, Davis as a food safety expert.

And I got a call from a person I knew at FDA and they said, hey, would you like to come to Washington, work at FDA and help us put this rule together? I jumped at the opportunity.

Jim moves his entire family 3000 miles across the country. And when he lands in Washington, his mission is to help figure out what should be the standard for keeping fruits and vegetables safe on farms? What should the FDA's inspectors, you know, actually inspect for?

Now, there are some basic things that everybody can agree on.

Things like worker health and hygiene, making sure that there's places for employees to wash their hands.

Also, things that sound basic, like making sure that farms are using clean water and that workers are handling compost and manure in a safe way. But Jim says a lot of those things are not quite as simple as they sound.

For example, say a farmer is walking through the fields and all of a sudden they notice a pile of animal poop.

Oh, no.

Right next to a beautiful green head of lettuce.

What they're supposed to do is flag it, cordon off an area around it, and that should never be harvested.

Is that part of the official rule? Yep. There's a poop rule. Oh, yeah. Poop is a big deal, of course, because a lot of the pathogens we're worried about. E. coli, salmonella, cyclospora, they are spread by poop. So obviously the farmer shouldn't harvest any lettuce that has poop on it, right?

But then the question comes is, OK, how close can I get to that one plant or that one pile there?

Yeah. Like, what about those nearby heads of lettuce? Are those contaminated, too? Like, how wide of an area do you have to cordon off?

These were real questions that Jim and his colleagues debated between themselves and also with the farmers. Jim says the farming industry supported these rules in theory, but farmers also didn't want to have to take unnecessary precautions.

So we really tried our best. But what we found is sometimes there's just not enough science. And unless you can show them the science, they don't want to do it.

So this whole process of gathering evidence and negotiating with farmers, it takes years, takes almost a decade. In fact, it takes all the way until 2019. That is when the FDA starts conducting routine farm safety inspections. And since then, FDA and state inspectors have visited thousands of farms with their clipboards and their checklists. And this is supposed to be a big deal, right? This is unprecedented. Have things been getting safer?

I would hope things are getting safer.

Hope is not the word that I was hoping you would say. Hope is not a strategy, right?

Yeah. The problem is these mass outbreaks keep happening. If you go to the FDA's website right now, you can see the warnings year after year. Thousands of people are still getting sick from salmonella and onions, from hepatitis and strawberries, E. coli and spinach, even while FDA inspections are happening.

And now this massive cyclospora outbreak. So what haven't we fixed yet? Why do these outbreaks keep happening? That is after the break.

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When Jim Corney first heard about this recent cyclospora outbreak, his initial reaction was, oh boy, here we go again.

To be honest with you, the way I feel is mostly like Odysseus. I've been on like Homer's epic poem, The Odyssey. I've been on an epic journey that ends with little progress, unfortunately.

And we asked him, why? After all this work that the government has done to overhaul the rules when it comes to farm safety, all the inspections that are happening, all the new safety standards, the poop rules, all of that, why doesn't it seem like we're making progress?

And from talking to Jim and reading all of the reports, there are a lot of reports on this, there seem to be three main problems. Problem number one is that the FDA's safety system isn't quite running at full speed yet. Yes, it has been 15 years since the law was passed to finally set safety standards for farms, but actually coming up with those standards has taken a lot longer than anyone wanted it to.

In fact, some of the most important safety standards were only finalized just two years ago. They have to do with how clean a farm's water has to be and what to do if there's runoff from an animal farm nearby. Some farms don't even have to comply with the new water standards until 2027.

Problem number two is that the FDA still doesn't have enough resources. It has all these new powers, but it doesn't have enough money. It doesn't have enough inspectors. Right now, there isn't even a regular inspection schedule for farms. Jim says that is a problem.

Once every three years would be ideal, you know, I mean.

Once every three years? I was hoping you would say, like, I don't know, every month. Every month? I don't know. I don't think that's possible. No? Why not? Why can't we have someone there all the time making sure that the poopy water isn't getting on the plants? I have to eat that. We all have to eat those plants. We do all have to eat that.

But right now, the FDA is not even inspecting farms every three years. The GAO recently published a big report on how the FDA was falling way short on inspections.

And this is a problem that extends far beyond the U.S. These days, 60 percent of our fruit is imported. About a third of our fresh vegetables are imported. We're recording this on Wednesday, July 22nd, and the FDA believes that the tainted cyclospora lettuce came from a farm in Mexico. But at the moment, it seems the FDA only very rarely inspects farms in other countries.

So for the FDA to go to a foreign country, first the FDA has to ask their permission to go to that foreign country. You don't just show up with your passport and say, hey, we're going to do inspections.

Yeah, Jim says it is way more complicated and way more expensive to conduct foreign inspections. So the vast majority of the time, the FDA relies on the companies that are importing the food. Those companies are supposed to make sure that the foreign farm or factory is following U.S. safety standards.

But Jim says even if the FDA had the budget to conduct all the inspections it needs to, and even if companies themselves conduct more audits and safety checks, which a lot of them do, that still wouldn't be the end of all these outbreaks. Because there's another, even harder problem to solve.

Which is that we just don't understand everything yet. A lot of the science is still a work in progress. Every time there's a new outbreak, scientists learn something new. For instance, a couple years ago, there was a big salmonella outbreak involving peaches. Which is weird because peaches grow on trees and they're away from the ground. they are not typically a fruit where you have to worry about salmonella.

The FDA pinpointed the outbreak to a farm in California, and when they sent agents out to investigate one of the orchards...

Come to find out, directly adjacent is a poultry house, you know?

Wait, so it was like chicken air that was just blowing onto these peaches? Yeah. Well, that is one of the theories, at least. The FDA never actually figured out how the salmonella...

got onto the peaches. When they visited, they couldn't even find a match for the same strain of salmonella that had gotten people sick. So to this day, this is still a mystery.

The mystery of chicken breeze.

Yes. Jim says there are a lot of mysteries like that in food science, particularly when it comes to the current pest on everyone's minds, cyclospora. Jim says there are tons of basic facts that we still don't fully understand about cyclospora, about how it spreads or where it hides. We don't even have super great tests for detecting cyclospora on our vegetables. With the current

outbreak, it's very possible that we'll never figure out exactly how it happened. And if we can't figure out how it happened, how are we going to prevent the next one? You know, talking to a

guy like Jim, who has spent his entire career studying ways that people get sick from food, it's enough to make anyone a little bit paranoid. So we were a little surprised when he told us that once in a while, even he will sneak a little piece of unwashed fruit.

Come on, we've all done it. You get a flat of strawberries at the local market and you start eating them in the car, man. You know, I mean, they're delicious. Look, if the water's been clean... You've done that. Oh, yeah. If the water's clean, if the soil's clean, if the person's hands are clean, it's all good.

Jim says there is always going to be risk when it comes to eating raw food. But we should also put those risks into perspective. Statistically, people are far more likely to get sick from food prepared in a dirty kitchen than they are from food that was grown in a contaminated field. Meanwhile, Americans are safely eating billions, billions and billions of pounds of lettuce every single year.

Getting sick from produce is a low probability event, but I like to liken it to a lightning strike.

It does happen, and sometimes it kills people. But it's also very, very unlikely.

Transcription by CastingWords And if you haven't joined yet, now is the time. Just go to plus.npr.org.

This episode of Planet Money was produced by me, Emma Peasley, with help from James Sneed. It was edited by Marian McCune. It was fact-checked by Sarah Wadas. Alex Goldmark is our executive producer. I'm Emma Peasley.

I'm Jeff Guo. This is NPR. Thanks for listening.

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