Bill Marler studied the dinner menu with professional care as he sat down to eat recently at Ramsay’s Kitchen, an upscale restaurant in St. Louis from celebrity chef Gordon Ramsay.
Marler, an attorney who lives outside Seattle, was in town for a court hearing involving several people allegedly sickened by romaine lettuce tainted with E. coli. It was fairly routine litigation in his long career of suing companies over foodborne illnesses, including some of the biggest outbreaks in the country stretching back to the early ’90s. That’s when he made his name going after Jack in the Box for undercooked hamburgers that sickened hundreds, killed four children and led to food safety reforms.
He’d not eaten a hamburger in decades. And he wasn’t about to start now, at dinner with opposing counsel.
Marler ordered a 6-ounce steak filet, well-done with cooked vegetables.
The other attorney ordered the same steak, cooked medium, plus a Caesar salad made with romaine.
“It’s interesting to see what other people do,” Marler said. “I tend to, because of my experience, take a more cautious approach to my food.”
Twenty years ago, Marler would have probably ordered a salad, too — he considered it the safer choice back then.
Now, he avoids leafy greens when eating out because he believes the risks have changed.
He orders his steak cooked gray, never pink. He won’t touch anything that comes precut — no fruit cups or veggie trays or bagged salads. No ready-to-eat meals. Also no sprouts or deli meats, said Marler. And he finds no solace in any food labeled organic. Those have all been sources of cases he’s worked on.
“I’ve seen too much. I’ve been in too many ICUs. I’ve been to too many funerals,” Marler said. “I know too much.”
Like the oncologist too attuned to all the subtle signs of cancer or the cop who sees danger lurking around every corner, Marler is perhaps overly aware of risks that most people don’t think about. It is the expert’s burden. He uses what he’s learned over the years in ways that might appear over the top.
Marler goes far beyond what federal health authorities suggest to avoid foodborne illnesses.
That advice focuses on how food is prepared — such as washing produce and cleaning surfaces — and how food is cooked, such as a minimum internal temperature of 145 degrees for beef or pork, 160 degrees for ground beef and 165 degrees for poultry. Most pathogens can’t survive high heat.
There is plenty of room to make the U.S. food supply safer, even though the chances of any one meal making you sick remain very low. An estimated 48 million cases of foodborne illnesses occur each year in the United States — striking 1 in 6 Americans, according to the Food and Drug Administration.
Most cases are manageable, if unpleasant, resulting in diarrhea and stomach cramps, sometimes vomiting.
But about 128,000 require hospitalization. And about 3,000 people die.
Some people face worse odds. The groups most at-risk of complications are children under 5, pregnant women and adults over 65.
Marler is 68. “I am at that age where foodborne pathogens could be really bad for you,” he said.
Food safety experts have different methods of dealing with the potential danger, said Martin Wiedmann, a food safety professor at Cornell, who knows Marler professionally.
“I do my own personal assessment of joy vs. risk,” Wiedmann said. While he eats almost anything, he pays close attention to how the food is cooked when eating out.
He slices open chicken to make sure it’s cooked all the way through. He avoids hot food buffets, because he doubts the temperature is hot enough. He’s willing to take a risk on street food in China, but only if it’s boiling. He avoids beef tartare no matter where he is. And while a well-done hamburger is a yes, sprouts are a no.
Wiedmann views foods like precut salads as a trade-off — it’s hard to know if a growing number of food-poisoning cases are tied to the particular product or just more cases are being found through increased consumption and better detection methods.
Health authorities struggle to know whether things are getting better or worse. Most cases of food poisoning are never reported. Even when they are, relatively few can be traced back to a source.
Earlier this year, a Government Accountability Office report blamed the “fragmented nature” of government regulation of the U.S. food supply for “inconsistent oversight, ineffective coordination, and inefficient use of resources.”
The GAO report called foodborne illnesses “a serious and continuing problem.”
Health authorities also face the challenge of food-poisoning problems that can turn up in a wide variety of sources.
Two large Listeria outbreaks in five years have been tracked by the Centers for Disease Control and Prevention to imported enoki mushrooms. The pathogen also has popped up repeatedly in caramel apples. In 2023, young children got Salmonella poisoning likely from touching contaminated dried dog food.
The CDC publishes a running list of multistate outbreaks, including current investigations into potential botulism tied to infant formula and listeria linked to prepared pasta meals.
The biggest change that Marler has seen in his career involves E. coli O157:H7. The feared pathogen can cause permanent kidney damage and death.
It was once closely tied to ground beef, as during the Jack in the Box outbreak. But federal regulators toughened standards and food companies created new procedures. Marler started to see E. coli cases drop in the early 2000s.
He remembers sitting in his law firm’s corner office on the 67th floor of the tallest building in Seattle, and thinking, “Now what am I going to do?”
He soon got his answer. “Romaine lettuce and ready-to-eat meats and cheeses filled in that gap,” he said. Today the biggest source of E. coli outbreaks are salad products. He sees more Salmonella and Listeria outbreak cases, too.
Illustrating the change was a multistate E. coli outbreak last year that sickened more than 100 people — including one death — who ate at McDonald’s restaurants.
But it wasn’t the hamburger meat that was contaminated. It was the onions, according to a CDC investigation.
Marler said his caution — like his preference for well-done steak — has resulted in chefs at high-end restaurants actually coming to his table to ask what’s wrong with him.
“I explain what I do for a living,” he said. “It’s an occupational hazard.” But it hasn’t protected him from getting sick.
He was in Idaho for a wedding and family reunion a few years ago. They shared a potluck dinner one night. Marler woke up the next morning “sicker than a dog.” He had the classic symptoms of a foodborne illness.
He never figured out where he got it.
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