The whole story: fresh milk in context

A common philosophy of the early organic farming and food movement was a central focus on the concept of ‘wholeness’. An organic farm functioned in its ‘wholeness’ as an integrated system of living organisms. Sir Walter Northbourne captured this philosophy of an organic farm saying it ‘must have a biological completeness: it must be a living entity’ where every ‘branch of the work is interlocked with all others’ (Northbourne, Reference Northbourne1940).

Eve Balfour, founder of The Soil Association (Brander, Reference Brander2003) became known as the ‘Voice of the Organic Movement’. In her bestselling book The Living Soil, she elaborated on the wholeness philosophy by extending the concept to food as in ‘whole diets’ (Balfour, Reference Balfour1976). She wrote: ‘The theory which I have endeavored to expound in this book is that the only true conception of health is one of wholeness, dependent upon both the continuity and the completeness of the cycle of life.’ She further argued that, ‘the health-giving property of food is dependent on the way it is grown, prepared and consumed.’ In her chapter on ‘whole diets’ she provides a review of how ancient peoples ‘preserved the wholeness of their health and that of their crops and livestock’ by summarizing the observations of medical pioneers in nutrition. She draws from the works Sir Robert McCarrison (McCarrison, Reference McCarrison1953), Weston A. Price (Price, Reference Price1950) and many others as examples of where healthy communities existed with virtually no physical or mental defects until their food culture was displaced by modern industrialized foods. While building the case for fresh whole foods sourced from fertile soils, she advocates for a ‘complete and continuous transference of health from fertile soil, through plant and/or animal to man and back to the soil again’. As a leading voice in the organic farming movement, Balfour was also a vigorous opponent of compulsory pasteurization (Tinker, Reference Tinker2000).

In an article in Organic Gardening magazine Sir Albert Howard (Howard, Reference Howard1946) wrote about ‘a famine of quality’ and the ‘murder of our daily bread’ as a result of growing food with artificial fertilizers and the use of modern processing to manufacture and denature foods. He refers to the work of Dr Weston Price as confirmation for his analysis of the problem and urges widespread distribution of Price's book Nutrition and Physical Degeneration. Howard recommends that schools provide nourishment to children as: ‘The produce including bread and the milk should come from humus-filled soil and should be consumed fresh.’

When Walter Northbourne outlined seminal concepts of organic farming in his 1940 book Look to the Land, he also accurately and insightfully characterized the current situation as it pertains to milk: ‘So long as people go on being fooled by advertisement (blatant or concealed) of processed foods, so long will they and the farmers be at the mercy of vast distributing concerns, whose every interest seems to be opposed to the people's real nutritional necessities. How can it be otherwise in a world of specialization and urbanization? Effective distribution seems to necessitate sterilization, which means killing, for failure to sterilize may mean infection in bulk. Hence the outcry for the pasteurizing of milk. But sterilization reduces the resistance to infection and the power of assimilation of the consumer of that which is sterilized. So yet more sterilizing seems to be necessary. A vicious circle again, of a type which should by now be familiar.’

In the United States where J.I. Rodale first popularized organic farming, he similarly drew connections between healthy soils, healthy food and healthy people. Following in the same vein as other organic pioneers, his publications frequently discussed how commercial and industrial food processing reduced its nutritional value. Similarly, Rodale's thinking was influenced by observations on traditional farming and food systems as described by Sir Robert McCarrison and Weston Price (Rodale, Reference Rodale1948). Ten years later (Rodale, Reference Rodale1958) in an Organic Gardening and Farming magazine article entitled ‘What Does Organic Mean’, he explicitly staked out the organic position against pasteurization: ‘It is not organic to produce milk organically, and then to pasteurize it.’

A recent report (Michigan Fresh Unprocessed Whole Milk Workgroup, 2012) states: ‘Milk fresh from the cow is a complete, living, functional food…the full benefits…are only realized when all of these components function as a complex interdependent and balanced process.’ This contemporary view on wholeness of food systems from a panel of experts is consistent with the philosophy of the early pioneers of organic farming. The list of ‘consumer preferences on production and management practices of fresh whole milk’ outlined in the Workgroup report is also consistent with the cultural practices associated with organic farming.

Milk problems and solutions

Among the parallels that exist between the fresh milk and organic farming movements are responses of a concerned farming and food community to the destructive forces of a modernizing and increasingly industrialized agriculture.

One of the myths about organic farming (Heckman, Reference Heckman2010) is that before the widespread use of synthetic chemical fertilizers and synthetic pesticides, the farming that was being practiced was organic without the banner of the name. While this was partly true in some places in the world, such as that described by F. H. King (Reference King1911) in Farmers of Forty Centuries or Permanent Agriculture in China, Korea, and Japan, it was clearly not so in many places where soils were being destroyed on a massive scale by erosion. Along with the soil erosion, there was also concern over loss of native soil fertility and soil organic matter content (Heckman, Reference Heckman2013). These problems were described in detail in the opening chapters of The Living Soil (Balfour, Reference Balfour1976) and in Look to the Land (Northbourne, Reference Northbourne1940). In these and other pioneering works, organic farming systems were proposed as a viable ecological solution to the crisis of soil destruction. In contrast, modern conventional agriculture chooses technological approaches to address soil erosion by promoting genetic engineering and chemical herbicide-no-till farming systems.

In the case of dairy farming, a serious health crisis was created in the late 1800s as a result of moving cows into crowded city feed lots and feeding them an unnatural diet (Schmid, Reference Schmid2009). In cities, the need for milk and the demand for whisky led to an unhealthy partnership for the mass production of both commodities. Urban centers have little pasture or forage available to feed cows. Swill, a by-product from the fermentation of grains to produce whisky, was a waste material commonly available from inner city distilleries. The feeding of swill to cows housed in deplorable and unsanitary conditions led to the production of unhealthy milk for infants and children, which in turn contributed to sickness and death.

The horrible conditions at a New York City dairy in 1842 were described by Robert Hartley (Reference Hartley1842): ‘Here, in a stagnant and empoisoned atmosphere that is saturated with the hot steam of whiskey slop, and loaded with carbonic acid gas, and other impurities arising from the excrements of hundreds of sickly cattle, they are condemned to live, or rather die on rum-slush. For the space of nine months, they are usually tied to the same spot, from which, if they live so long, they are not permitted to stir, excepting, indeed, they become so diseased as to be utterly useless for the dairy.’

In some respects, the filthy inner city dairies of the 1800s were like an early version of the modern concentrated animal feeding operation or CAFO (Imhoff, Reference Imhoff2010). Livestock raised in CAFOs are exposed to an abundance of manure, an absence of sunny pastures and in general conditions where pathogens may flourish. The abundance of manures produced by CAFO operations are often linked to cases of food-borne illness (Erickson and Doyle, Reference Erickson and Doyle2012). Chemical treatments, irradiation or high-pressure processing are proposed as technical solutions (National Advisory Committee on Microbiological Criteria for Foods, 2004) to food safety problems that might be avoided by changing to ecological methods of farming.

Similarly, pasteurization of milk, often described as a major public health victory, became a technological solution to a man-made problem. A century of pasteurizing milk is a relatively short history compared with the thousands of years during which humans evolved in association with consuming animal milk without pasteurization (Curry, Reference Curry2013). Although not all peoples of the world became consumers of dairy, the archeology of milk suggests Europeans that did were apparently advantaged both in terms of fertility rate and a more secure food supply. In 1935, Weston A. Price, while traveling through parts of Africa, observed that the herders of cattle and goats, living primarily on dairy products, were similarly advantaged relative to non-herders (Price, Reference Price1950).

Mark McAfee refers to the modern era of dairy and the introduction of pasteurization with the phrase: ‘Pasteurization was an 18th century solution to an 18th century problem’ (McAfee, Reference McAfee2013). Out in the countryside where cows were kept on pasture, fresh milk was generally a wholesome food when consumed fresh or fermented (Schmid, Reference Schmid2009). The movement toward milk pasteurization did not begin in the countryside but rather in the cities where cows were housed in deplorable conditions and fed an unnatural diet. Compounding the milk problem was a lack of refrigeration and a food distribution system based on limited scientific knowledge and without standards for sanitation and hygiene (DuPuis, Reference DuPuis2002).

This set of circumstances, where milk could be easily contaminated with pathogenic bacteria, suggested the need for a kill step such as heating to a specific temperature and time period to make the milk safe. Pasteurization, a process originally invented for preserving wine, was initially promoted by a wealthy businessman, Nathan Strauss, and eventually became widely adopted by the dairy industry (Schmid, Reference Schmid2009).

A completely different approach to securing clean fresh milk for infants and children was pursued by Dr Henry Coit, MD, a pediatrician from Newark, New Jersey (Rogers, Reference Rogers1955). A commemorative poster (Heckman, Reference Heckman2011) in the hallway at Beth Israel Hospital (Originally known as Babies Hospital) describes the medical and pioneering accomplishments of Dr Coit: ‘A Pioneer in American Pediatrics, Henry L. Coit, MD, begins his lifelong crusade for better infant feeding and cleaner milk, following the death of his first son at age two from intestinal disease. In 1892, Dr Coit outlines a program for purification. Two years later, the world's first bottle of certified milk, handled entirely under medical supervision, is delivered. Soon Babies Hospital delivers pure certified milk to families throughout Newark. At its peak, the program distributes 150,000 bottles per year.’

Rather than implement a kill step like pasteurization to make poorly produced milk safe, Dr Coit instituted a set of practices for better dairy stewardship. Dr Coit found that many dairy farmers of the time lacked knowledge of hygiene to produce clean milk. Being well aware of the challenges involved, Dr Coit ‘devised a plan for a professional body composed of physicians, which should first educate, then encourage and finally endorse, the work of dairymen who would bring to us milk designed for the most exacting needs of physicians’. His plans also specified production practices, inspections and certification under a legal contract with the dairy farmer (Rogers, Reference Rogers1955). Under the leadership of Dr Coit, the first Medical Milk Commission was established in Essex Country, New Jersey in 1893. By 1896, over 60 Medical Milk Commissions were operating around the world.

In 1909, the New Jersey State Department of Health adopted the definition of certified milk that originated (Rogers, Reference Rogers1955) from Dr Coit: ‘Certified milk is a product of dairies operated under the direction of a medical milk commission, which body is appointed for voluntary service by a medical society. The milk is designed to fulfill standards of quality, purity and safety to ensure its adaptability for clinical purposes and the feeding of infants.’

Certified milk continued to be available as a choice in New Jersey at least up until 1971 when the Walker–Gordon Farm in Plainsboro, New Jersey closed. Milk certified by the Medical Milk Commission bottled at Walker–Gordon Farm was shipped by rail to Philadelphia and New York. The dairy began its operation in Plainsboro in 1897 and provided fresh unpasteurized milk to the surrounding communities for many decades and even after1964 when New Jersey legislation made raw milk distribution illegal.

The loss of this special fresh milk is described in an excerpt from a book entitled Walker-Gordon, One of a Kind (Tindall and Clark, Reference Tindall and Clark1998): ‘For those of us who grew up with the taste of fresh, really fresh, whole milk, unadulterated in any manner except to chill it ice cold, today's milk is a sad replacement.’

In the early 1900s, many medical doctors recommended pure raw milk over pasteurized milk (Anonymous, 2010). ‘Certified milk’ was the way Dr Coit envisioned providing infants and children with fresh pure milk without pasteurization. For several decades, people were allowed a choice to buy either certified milk or pasteurized milk. Historically, food protection associations generally agreed and allowed for an exception to mandatory pasteurization in the case of certified milk (International Association of Food Protection, 2014).

Certified milk was at a disadvantage in a market place due to the added expense of producing clean fresh milk. In some instances, the production of pasteurized milk was subsidized. Eventually pasteurization became the dominant process as it allowed dairy farming and milk processing to industrialize on a massive scale (Schmid, Reference Schmid2009).

Like certified organic farming, certified milk production adhered to a set of standards to guide food production even if for different reasons. In the case of organic farming, certification directs ecological stewardship of soils, crops and livestock without the use of most conventional chemical inputs of questionable safety. With certified milk, the emphasis was on better dairy farming practices and careful milk handling to produce clean milk. Inspections are part of both certification systems. The good hygiene required to produce certified milk played a part in raising the standards for the entire dairy industry including that of raw milk intended for pasteurization (Rogers, Reference Rogers1955).

The sanitary handling procedures and standards for milk production intended for processing are codified in the US Food and Drug Administration (FDA) regulations as outlined in the Pasteurized Milk Ordinance (PMO). The PMO standards do not apply nor are they appropriate for dairy farms producing raw milk that will be consumed as fresh unprocessed milk. Individual states that permit raw milk sales or distribution vary widely in standards and regulation.

The absence of national standards for production of unpasteurized milk for direct human consumption inspired the founding of the Raw Milk Institute (RAWMI) by an organic dairy farmer (McAfee, Reference McAfee2011). Established in 2011, RAWMI mentors and trains producers of fresh unpasteurized milk. As described on its website, it ‘facilitates best practices in the raw milk industry through the evaluation of research findings’ and farm experience to create individualized food safety plans. Dairy farms that work with RAWMI adopt a set of standards; develop a risk assessment and management plan and safe operating procedures that are customized to the unique environment of the farm.

In some respects, the writing of this plan for an individual farm is analogous to writing an organic farm plan for organic certification. As with certified milk, the RAWMI emphasizes training and carefulness of the production. Producing a clean high-quality fresh unprocessed food within a system of farming and verifying the integrity of that system is not unlike goals for organic certification (Johnston, Reference Johnston2014).

The economic disadvantage of regulated and permitted raw milk arises from the special procedures for minimizing risk, which results in a food with higher production costs than pasteurized milk. Producing certified organic foods may be economically disadvantaged for similar reasons. However, premiums that consumers are willing to pay for organic food tend to improve the profitability of organic farming (Kantor, Reference Kantor2015).

Quality, hygiene and food safety

The legacy of Dr Coit serves to draw a distinction between the health impacts of carefully produced legitimate food-quality fresh milk intended for direct human consumption and processor-quality raw milk, which is produced knowing that pasteurization will follow. Dr Coit and the Medical Milk Commission were very concerned about both the benefits of the milk for their patients and the public health effects of dirty milk. This crucial distinction is often ignored in public discourse. Thus, when public health officials issue warnings about raw milk consumption or cite illness or outbreak statistics, they typically make no distinction or give little consideration to how milk is produced. It is simply labeled ‘raw’.

For example, it is useful to examine statements issued by the Centers for Disease Control (CDC) and other food safety officials:

‘Raw milk is milk from cows, goats, sheep, or other animals that has not been pasteurized.’

‘No matter what precautions farmers take, and even if their raw milk tests come back negative, they cannot guarantee that their milk, or the products made from their milk, are free of harmful germs.’

‘Dairying methods have improved over the years but are still no substitute for pasteurization in ensuring that milk is safe to drink. Raw milk supplied by “certified,” “organic,” or “local” dairies has no guarantee of being safe.’

While these statements from the CDC may be partly true, they seem to imply that not only is pasteurization the only safe option, but that it ‘guarantees’ safety. They also set up an impossible standard for any food to achieve.

The CDC is not alone. Some food scientists (Lally, Reference Lally2011) accept the fact that ‘there is no way to guarantee the safety of any food’. However, other scientists (Claeys et al., Reference Claeys, Cardoena, Daubeb, De Blockc, Dewettinckd, Dierickd, De Zutterd, Huyghebaertd, Imberechtsd, Thiangeg, Vandenplash and Hermanc2013) write about how milk is ‘heat treated’ to ‘guarantee its microbial safety’.

A careful look in the historical record for pasteurization shows that it does not guarantee food safety. Any food, including raw or pasteurized milk, can be associated with food-borne illness (Real Raw Milk Facts, 2005–2017). Although dairy in general is among the safest of foods, a few notable examples of well-documented illness and deaths linked to pasteurized milk show that pasteurization does not guarantee safety. Very rarely do news stories that highlight the risks associated with raw milk drinking ever acknowledge the reality of illnesses or deaths linked to pasteurized milk. Thus, it is essential for a balanced discussion to at least present some of the food-borne illness data linked to pasteurized milk. In 1985, it was estimated that more than 168,000 people were sickened with Salmonella from pasteurized milk (Ryan et al., Reference Ryan, Nickeles, Hargrett-Bean, Potter, Endo, Mayer, Langkop, Gibson, McDonald, Kenney, Puhr, McDonnel, Martin, Cohen and Blake1987). In 2007, Listeria from pasteurized milk was linked to three deaths. Furthermore, according to this report on these deaths linked to Listeria, ‘records indicate that pasteurization methods at the dairy were adequate’ (CDC, 2008). A more recent analysis (Stasiewicz et al., Reference Stasiewicz, Martin, Laue, Grohn, Boor and Wiedmann2014) indicated that on average 18 deaths occur annually from consuming pasteurized milk and that increased risk is related to increasing temperatures used for pasteurization.

Consumption of fresh milk, as with any food, is associated with some level of risk. People unwisely sometimes drink commodity raw milk intended for pasteurization or they may drink raw milk from a black market source. Amateurs can get involved in raw milk production without adequate training and provide an unsafe product; but without drawing a distinction between legitimate food-quality fresh milk carefully produced from healthy cows and commodity raw milk produced under PMO standards (which do not require testing for pathogens, and allows commingling of milks from many farm bulk tanks intended for pasteurization), the level of actual risk of drinking carefully produced fresh milk remains impossible to accurately quantify.

The three main pathogens of public health concern with unpasteurized milk are Campylobacter jejuni, the shiga-producing strains of Escherichia coli and Salmonella. These pathogens are commonly found in bulk tank commodity raw milk intended for pasteurization; but in carefully produced fresh unprocessed milk, they are found only on rare occasion (Baars et al., Reference Baars, Beals, Beals, Brown, Cattell, Heckman, Nelson, Snyder, Wilson and Wightman2015). The Real Raw Milk Facts website, which reports illnesses and deaths attributed to either raw milk or pasteurized milk, makes no distinction between commodity raw milk intended for pasteurization and carefully produced clean raw milk produced for fresh consumption.

Several recent studies conclude that raw milk is a high-risk food, which poses a risk for outbreaks 150 times greater than pasteurized milk (Langer et al., Reference Langer, Ayers, Grass, Lynch, Angulo and Mahon2012). Critics have challenged these studies’ underlying assumptions, the confusion between outbreaks vs number of illnesses per outbreak, the estimated population size of raw milk consumers and the time frame for data inclusion or exclusion (Kresser, Reference Kresser2012; Weston A. Price Foundation, 2012).

When outbreaks attributed to raw milk occur, they are generally associated with a small number of illnesses per outbreak. The illnesses are generally traceable back to or linked to a single dairy farm that serves a small community of customers from a relatively small herd of dairy animals.

In contrast, pasteurized milk is usually obtained by pooling milk from numerous farm bulk tanks, and when outbreaks do occur, they can be very large. For example, the earlier cited outbreak from salmonellosis traced to pasteurized milk was described as ‘massive’ and made it the largest ever identified outbreak in the United States (Ryan et al., Reference Ryan, Nickeles, Hargrett-Bean, Potter, Endo, Mayer, Langkop, Gibson, McDonald, Kenney, Puhr, McDonnel, Martin, Cohen and Blake1987).

Proponents argue that where raw milk sales are legal, regulated and widely available, the number of illnesses associated with raw milk drinking is self-limited and manageable, as much as it can be with other foods (Weston A. Price Foundation, 2012). Cooperation from public health agencies and training of fresh milk producers in best practices could conceivably further improve its safety.

The current situation also raises questions: Why is less than perfectly safe a manageable risk for every kind of food except in the case of fresh unpasteurized milk? Why are no other foods held to the impossible standard of a perfect safety record?

Proponents argue that when compared with many other foods, the number of illnesses associated with fresh milk consumption is comparatively small. For example, at the International Association of Food Protection, Raw Milk Debate in 2016, it was shown that leafy greens are at the top of the list for most risky food. Even when compared at the same level of consumption, leafy greens are several times more risky than raw milk. Some further argue that there are health implications from prohibiting access to raw milk because doing so removes the potential for people to receive the health benefits (discussed below) uniquely associated with drinking fresh milk.

For the last several decades public health officials and food safety scientists have almost exclusively focused on warning and educating people against consuming fresh milk by highlighting safety concerns. Documentary films Farmageddon, Organic Hero or Bioterrorist and Milk War have provided graphic illustration of clashes over raw milk between government agencies on one side and dairy farmers and consumers on the other.

A psychiatric physician attending one of the raw milk seminars at the Rutgers University (Schwartzman, Reference Schwartzman2010) and well-versed in the dynamics of mass psychology spoke up about how the battle over legal access to raw milk was about much more than just food safety. In his blog (Government vs Raw Milk) he defines and explains a social phenomenon called the emotional plague as originally outlined by Dr Wilhelm Reich. Schwartzman explained: ‘I contend no matter how much proof of safety is presented or what additional information is provided, the government authorities will never relent in their efforts to end sales of unpasteurized milk…The safety of unpasteurized milk and the best interest of the public are not the sole or even primary reason for the government's attack… In their minds they must stop ‘dangerous’ activities and behaviors, never realizing their prohibitive actions are not really for good of others but rather to make themselves feel better by putting an end to the behavior that makes them intensely anxious. Controlling others makes plague-ridden individuals feel better, at least temporarily.’

Antagonistic campaigns against a farming system are another parallel between the raw milk and organic farming and food movements. When the USDA Secretary of Agriculture, Earl Butz declared ‘Before we go back to organic agriculture, somebody is going to have to decide what 50 million people are we going to let starve’, he dismissed organic as a viable system of farming. Similarly, John F. Sheehan (Reference Sheehan2005) of the FDA declares that, ‘Raw milk is inherently dangerous’ and that, ‘Drinking raw milk or eating raw milk products is like playing Russian roulette with your health.’ Such statements appear intended to frighten people away from consuming unpasteurized dairy regardless of the carefulness of production.

In spite of such pronouncements from public officials and the interests of agricultural industries and food manufactures, as with certified organic production, farmers and consumers are making personal choices toward a new food movement. Educational campaigns against access to raw milk may be seen as a failure given that demand for pasteurized fluid milk has been steadily declining (Berry and Gee, Reference Berry and Gee2012), whereas the growth in demand for permits to sell raw milk has been described as ‘explosive’. Research and support from the Cooperative Extension System for careful production of raw milk needs to catch up with the educational resources available for the organic system of farming. Publication of the book on Producing Fresh Milk, The Cow Edition (Baars et al., Reference Baars, Beals, Beals, Brown, Cattell, Heckman, Nelson, Snyder, Wilson and Wightman2015) and Producing Fresh Milk, The Goat Edition (Baars et al., Reference Baars, Beals, Beals, Brown, Cattell, Heckman, Nelson, Snyder, Wilson and Wightman2017) are examples of educational efforts in this direction.

Policy toward raw milk availability varies widely among countries. In the United States, there are as many different policies and different levels of availability of raw milk to consumers as there are states (Farm to Consumer Legal Defense Fund, 2016). In spite of the FDA policy prohibiting transport of raw milk across state borders by farmers, consumers frequently cross borders to procure raw milk. In Canada, raw milk is completely prohibited with the exception of the unsettled gray area of the law where consumers buy into ownership of the dairy farm. In India, Bangladesh and Pakistan, fluid milk is widely available for consumption without processing. Australia strongly prohibits raw milk distribution, while New Zealand permits raw milk sales at the farm. In many European countries, raw milk is widely available as retail sales or directly from dairy farms with the help of raw milk vending machines (Brasch, Reference Brasch2014). What these different levels of restriction or access appear to illustrate is that consuming regulated raw milk does not lead to an overwhelming number of food-related illnesses.

Mainstream attention, policy changes and the role of leadership

Organizations dedicated to teaching people about fresh milk strongly urge that the milk should be produced from pasture-fed animals and not raised in continuous confinement (Gumpert, Reference Gumpert2015; Shetreat-Klein, Reference Shetreat-Klein2016). Large-scale industrial or confinement operations that emphasize high levels of production per animal unit are not perceived to be a good source for fresh milk due to concerns over animal welfare and sustainability. These guidelines are aligned with the USDA-NOP standards that require pasture feeding of animals (Code of Federal Regulations, 2015) and the traditional philosophy of organic dairy farmers to accept less intensive inputs described as a ‘refusing to push the cows’ (Saucier and Parsons, Reference Saucier and Parsons2014). That fresh milk be produced by a certified organic operation is not necessarily the point, but rather that the dairy uses many organic production practices that serve to enhance milk quality and ensure animal welfare (Baars et al., Reference Baars, Beals, Beals, Brown, Cattell, Heckman, Nelson, Snyder, Wilson and Wightman2015). Such production practices are assumed to reduce risk but their value and effectiveness need research for validation or further improvement.

Until recently, and after several decades of hostility, agricultural universities and the Cooperative Extension System gave little research support to the organic system of farming (Lipson, Reference Lipson1997). Currently virtually every agricultural university exhibits some level of support for organic farming. In some cases, there are now professors at major agricultural universities dedicated full time to research and educational programs on organic farming.

Yet in more than 100  yr of the Cooperative Extension System, there has been very little effort dedicated to research or training of dairy farmers in the careful production of fresh milk to be consumed without pasteurization. Despite the fact that fresh milk is a legal beverage in all states (at least from a family cow or goat) and can be legally sold from the farm or retail in many states, the Cooperative Extension System has not met its responsibility to be truly transformational in its educational programing by serving fresh milk dairy producers and consumers (Heckman, Reference Heckman2007). Contrary to helping fresh milk dairy farms produce a safer product, with few exceptions (Hoenig, Reference Hoenig2014), the focus of the Cooperative Extension System has been warning people of the dangers of drinking unpasteurized milk and driving people away from their personal food choice (Schutz and Ferree, Reference Schutz and Ferree2012).

Recently, Raw Milk Workshops (2014, 2015) were held at the Penn State University and at the State University of New York–Cobleskill. These notable exceptions may be a sign of some specialists within the Cooperative Extension System accepting a role in the training of raw milk dairy farmers. The workshops objectives were designed to teach science-based food safety principles to help create a secure foundation for the growing raw milk movement. Speakers included veterinarians and experienced raw milk dairy farmers.

As with success in organic farming, innovations with fresh milk production and safety have been associated with working farms, which historically received little to no assistance from agricultural universities and the Cooperative Extension System. One might assume that people will never stop a 10,000-year-old tradition of producing and drinking fresh milk. If anything the number of people choosing fresh whole unprocessed milk appears to be rising in spite of public health agencies discouraging fresh milk drinking.

Other organizations have stepped in to serve farmers and consumers when the Cooperative Extension System fails to provide a necessary service. The historic guidance for the production of Certified Milk by Medical Milk Commissions, the more recent establishment of the RAWMI and educational efforts of the Farm-To-Consumer Foundation, were initiated by actors almost entirely outside of universities and the Cooperative Extension System. In the case of the RAWMI, it was established by Mark McAfee, the owner of the largest organic raw milk dairy in North America.

Agricultural universities and the Cooperative Extension System typically follow the lead of federal authorities. Federal agencies strongly opposed to allowing people to choose fresh milk could potentially reverse direction under new leadership. Such was the case when the Secretary of USDA Bob Bergland decided to take a look at organic agriculture in the 1970s. It was an ‘across the fence conversation’ with a neighboring organic farmer that sparked the talks and surveys between USDA and the organic community (Youngberg and DeMuth, Reference Youngberg and Demuth2013). In 1980, the USDA published its Report and Recommendations on Organic Farming (USDA, 1980).

In the forward of that USDA document, Bob Bergland writes about gaining an understanding of organic farming systems and the need for research, education and communication.

What would happen to the fresh/raw milk movement with a similar change in attitude of government officials?

Several years after passage of the Federal Organic Food Production Act of 1990, the Organic Farming Research Foundation surveyed the USDA's Current Research Information System for pertinence to organic farming. The findings from that survey were summarized in ‘Searching for the O-Word’ (Lipson, Reference Lipson1997). By revealing a lack of USDA commitment to organic farming research, the report became a catalyst for increasing levels of financial and institutional investment in such work.

The uneven legal status of fresh milk sales within the states and FDA policy may be an even greater hurdle to getting USDA support for research and the Cooperative Extension System teaching on production and safety. Recent trends toward legalization or administrative policies among numerous states are allowing increased access to fresh/raw milk (Kennedy, Reference Kennedy2016). Currently there also appears to be a relaxing of restrictions against dairy farmers providing fresh milk. Even more important than research support is the desire among raw milk dairy farmers and the people who want access to fresh milk to simply be left alone and to have their food choice respected (Gumpert, Reference Gumpert2013).

Health outcomes, subjective experience and the ‘great subject’

The holistic view of health and nourishment concerning soils, plants, animals and people sets the traditional organic system of farming apart from conventional agriculture. This broad ecological perspective was expressed by Albert Howard (Reference Howard1943) when he wrote about ‘the whole problem of health in soil, plant, animal and man as one great subject’.

Eating food serves numerous health functions, not the least of which is pleasure and satisfaction. In the case of full fat unprocessed fresh milk many people claim to have a different drinking experience (Katafiasz and Bartlett, Reference Katafiasz and Bartlett2012). Commodity pasteurized and homogenized milk is usually comingled with many farms and processed for consistent flavor throughout the year. In contrast, people consuming fresh milk directly from specific farms can experience the flavors as they vary with the quality of pasture or feed, growing season, geography, animal breed and carefulness of the milking operation (Gumpert, Reference Gumpert2015). People who drink and appreciate the flavors and mouth feel of quality fresh milks are every bit as much connoisseurs as those who consume fine wine. The satisfying value and pleasurable experience with artisanal foods such as fresh milk are too often undervalued or ignored by the proponents of industrialized agriculture (Mincyte, Reference Mincyte2014). Health benefits are also similarly dismissed and ignored.

When a food is deconstructed and its chemical constituents measured in an analytical laboratory, the nutrient concentrations are itemized but not functionally understood. Studies comparing nutritional composition of organically grown food and conventional food usually stop short of investigating how the food objectively functions in a living organism (Carr et al., Reference Carr, Delate, Zhao, Cambardella, Carr, Heckman, Brevik and Burgess2012), let alone how it subjectively functions. In the case of fresh vs pasteurized milk, nutrient content reports usually acknowledge that pasteurized milk results in some loss of a few nutritional components, such as vitamin C. They may go further and say that milk is not a significant source of such nutrients anyway.

Although nutrient content data can be useful, it does not tell the full story. For example, it does not tell us much of anything about the eating experience and the role that qualitative factors play in health and satisfaction. Surveys have shown that the number one motivation for drinking fresh unprocessed milk is taste (Katafiasz and Bartlett, Reference Katafiasz and Bartlett2012). This is very important because dietary health benefits can only come from foods people are willing to eat.

Often the personal experiences of health outcomes expressed by people switching from drinking pasteurized milk to fresh milk are not taken seriously. Rather than viewed as preliminary lines of evidence for formulation of hypothesis and follow-up research, the potential health benefits of drinking fresh milk are too quickly dismissed as anecdotal and not worthy of further investigation.

The values of the numerous biologically active factors in fresh milk that are diminished or inactivated by the heating process of pasteurization are reviewed in the report by Michigan Fresh Unprocessed Whole Milk Workgroup (2012). Besides nutrient bioavailability, this report recognizes the valuable role of bacteria in providing prebiotic and probiotic functions, and active enzyme systems that assist digestion. The report also cites studies indicating that drinking fresh milk protects against allergies and asthma. It further notes some people who are not able to drink pasteurized milk have tolerance for drinking fresh milk. Unlike most reviews, this report is unusual in that it acknowledges these special attributes of fresh milk.

Any evidence for health outcomes uniquely associated with consuming fresh unpasteurized milk is typically dismissed with blanket pronouncements. For example, the CDC (Raw Milk Question and Answers, 2017): ‘There are no health benefits from drinking raw milk that cannot be obtained from drinking pasteurized milk that is free of disease-causing bacteria.'

The US FDA similarly plays up the risks and dismisses the benefits. How some public health organizations, community of health professionals and food scientists can ignore the accumulated published evidence on health benefits appears biased or a willful failure of scholarship.

However, it appears that as the scientific literature (showing that raw milk offers unique protection from allergies, asthma and respiratory infections) is made easily available, it can no longer be so blatantly ignored. As an example, in response to political pressure from the state of Maryland, the legislature called upon public health professionals at the Johns Hopkins University for an opinion on raw milk. A published report entitled: A Literature Review of the Risks and Benefits of Consuming Raw and Pasteurized Cow's Milk (Davis et al., Reference Davis, Li and Nachman2014) concluded that ‘there is no scientific evidence supporting the claim that the benefits of raw milk outweigh any health risk.’ While this review did not entirely please the proponents for legalizing access to fresh milk in Maryland, it did review and acknowledge some evidence for health benefits from fresh milk consumption at least for its association with reduced allergies. As may be expected from mainstream sources, the report also strongly discouraged the drinking of fresh milk.

There are many other examples of this narrative that magnifies risks while ignoring, downplaying or dismissing the benefits. While it is extremely difficult to change an establishment position, one approach to shifting the debate is to study a subject in depth and to challenge the experts by exposing the contradictions of their words (Martin, Reference Martin1996). A few well-informed and vocal critics can spur a movement and sometimes make an enormous difference.

People concerned with making food choices have several options: (1) place their trust in the pronouncements of the ‘experts’, (2) ask a trusted health care professional, (3) read and review published literature and arrive at their own interpretation and assessment, or (4) become knowledgeable about their food choices from real-world experience.

The fourth option is not unlike what farmers and gardeners experience when they decide to implement organic practices on their land. When a farmer transitions away from commercial chemicals to the organic system, they observe the unique qualitative changes in soil properties that result from switching to a biologically based soil fertility system. The special soil properties achieved and the benefits to plants of feeding the soil with complex organic nutrient sources are now well documented and cannot be dismissed as simply anecdotal (Rodale Farming System Trial, 2016). The increases in soil organic matter content, ease of tillage, water infiltration, biological activity, drought tolerance and disease suppression are expressions of soil health typically observed when organic farming is compared with conventional chemical farming (Carr et al., Reference Carr, Delate, Zhao, Cambardella, Carr, Heckman, Brevik and Burgess2012).

The analogy of feeding soil or feeding people with naturally occurring whole biologically active substances is a concept very much in tune with the philosophy of the organic farming movement. The observations on soil health or human health that follow from it may be considered subjective and therefore subject to criticism from the scientific establishment; but for individuals with positive experiences with organic systems nothing matters more or is more convincing than these personal experiences (Padel, Reference Padel2001). Nevertheless, the organic community also welcomes scientific studies that can provide objective validation for their subjective experiences.

When considering food choice, the third option is the most difficult and time consuming and therefore the least likely path taken. Nevertheless, in service to the stated goal of informed consumer choice, Table 2 outlines the newer as well as the older published literature on health properties and nutritive values associated with fresh unprocessed milk in contrast to pasteurized milk. This listing includes studies and literature references (drawn from the extensive collection described in the Methods section) that include both human milk as well as that of other lactating animals.

Table 2. Literature summary on health and nutritional responses associated with raw or heat treatment of animal milk and human milk. The listed studies generally refer to bovine milk unless indicated to be human milk

The body of scientific literature comparing fresh milk vs heat-processed milk suggests that health outcomes are often different (Table 2). The evidence is based on animal as well as human feeding trials using cow milk or human breast milk. It generally shows that when milk is heated, some of the nutritive qualities are diminished; weight gains and growth are often less with heat-treated milk. The more recent studies indicate that consuming fresh milk helps protect children from allergies, asthma and respiratory infections (Waser et al., Reference Waser, Michels, Bieli, Flöistrup, Pershagen, von Mutius, Ege, Riedler, Schram-Bijkerk, Brunekreef, van Hage, Lauener and Braun-Fahrländer2007; Braum-Fahrlander and von Mutius, Reference Braum-Fahrlander and von Mutius2010; Loss et al., Reference Loss, Apprich, Waser, Kneifel, Genunet, Buchele, Weber, Sozanska, Danielewicz, Horak, van Neerven, Heederik, Lorenzen, von Mutius and Braum-Fahrlander2011). The literature also notes that unpasteurized milk has immunologic factors and anti-microbial properties that decrease when heat treated (Loss et al., Reference Loss, Depner, Ulfman, van Neerven, Hose, Genuneit, Karvonen, Hyvärinen, Kaulek, Roduit, Weber, Lauener, Pfefferle, Pekkanen, Vaarala, Dalphin, Riedler, Braun-Fahrländer, von Mutius and Ege2015; McCarthy et al., Reference McCarthy, Ross, Fitzgerald and Stanton2015).

There are also some studies reporting no meaningful differences when comparing raw vs pasteurized milk for lactose tolerance (Mummah et al., Reference Mummah, Oelrich, Hope, Wu and Gardner2014), protein quality or mineral availability (Weeks and King, Reference Weeks and King1985, and Zurera-Cosano et al., Reference Zurera-Cosano, Moreno-Rojas and Amaro-Lopez1994). On balance, however, many studies provide evidence of health benefits associated with milk consumed fresh.

In spite of the acknowledged evidence for improved health outcomes from consuming raw milk, authors of such studies apparently feel compelled to incorporate a personal opinion against drinking fresh milk due to the potential presence of pathogens (Waser et al., Reference Waser, Michels, Bieli, Flöistrup, Pershagen, von Mutius, Ege, Riedler, Schram-Bijkerk, Brunekreef, van Hage, Lauener and Braun-Fahrländer2007; Loss et al., Reference Loss, Depner, Ulfman, van Neerven, Hose, Genuneit, Karvonen, Hyvärinen, Kaulek, Roduit, Weber, Lauener, Pfefferle, Pekkanen, Vaarala, Dalphin, Riedler, Braun-Fahrländer, von Mutius and Ege2015). They also call for further research on finding, isolating or preserving the protective components of fresh milk (Perkin, Reference Perkin2007; Waser et al., Reference Waser, Michels, Bieli, Flöistrup, Pershagen, von Mutius, Ege, Riedler, Schram-Bijkerk, Brunekreef, van Hage, Lauener and Braun-Fahrländer2007). This approach would seem to be at odds with the whole natural foods philosophy of traditional organic food systems. What is missing from their recommendations is a pursuit of research and education for dairy farmers on how to improve the quality of fresh milk and its production practices.

Until recently, the organic farming systems received only very limited research and educational support from agricultural universities. The increasing abundance of organic food in the market place shows that organic farming can function as a viable system of food production with or without the help of institutional support. In a similar fashion, researching ways to reduce risks and improving production practices may enable more people to consume wholesome fresh milk without pasteurization and receive accompanying health benefits.

Published scientific literature is always open to interpretation and continuous reinterpretation in the context of current science. From the summary (Table 2) and reference list, ‘citizen scientists’ willing to make the effort can more quickly find pertinent literature and read and interpret it for themselves for the purpose of making an informed food choice.

Policy impacts on soil fertility, sustainability and health

The pioneers of the organic farming movement placed great emphasis on health in connection with soil fertility. Howard (Reference Howard1943), for example, wrote of a ‘great linkage between the soil, the plant and the animal.’ and furthermore declared that ‘Soil fertility is the basis of the public health system of the future’ (Howard, Reference Howard1972). The authors (Baars et al., Reference Baars, Beals, Beals, Brown, Cattell, Heckman, Nelson, Snyder, Wilson and Wightman2015) of the book on Producing Fresh Milk, The Cow Edition would agree with the organic farming concept that mineral-rich fertile soils are one of a large number of factors promoting healthy dairy animals and enhanced quality fresh unprocessed whole milk.

Albert Howard (Reference Howard1972) was also very much cognizant of the function of livestock on soil fertility when he wrote that ‘Mother nature never farms without live stock….’ Cows as part of the farm ecosystem are effective transformers of relatively low nutrient density forages into nutrient-rich foods with fat-soluble vitamins, proteins and energy-dense fats (Heckman, Reference Heckman2015). On dairy farms, there is a flow of soil fertility through the cow (Bear, et al., Reference Bear, King and Bender1946). Although cows do extract a fraction of the minerals from their feed to make milk, the larger fraction of the minerals contained in feeds and forages are recycled back to the land through manure application.

Pasture-based dairy farming systems are one of the most effective ways to build soil organic matter content and soil fertility in general (Heckman, Reference Heckman2015). This organic fraction of the soil is a valuable storehouse for carbon, nitrogen, phosphorus, sulfur and other plant nutrients. Pastures under organic management are ideally a mixed stand of legumes and grasses. This diverse mix enables a farm to be self-sufficient in nitrogen. This biologically captured nitrogen as part of a well-designed crop rotation is supportive of an entire organic farming operation. In this way, pasture and perennial forage crops are foundational attributes of an effective organic farm plan.

Whether organic milk from a dairy farm is provided directly to consumers as fresh milk or as pasteurized milk makes little difference in terms of how soil fertility functions on the farm. However, milk policy can have a huge influence on the number, size and distribution of dairy farms and thereby sustainable soil fertility.

Dairy farms in the business of providing fresh milk directly to consumers are typically smaller operations with a local community of patrons. These dairy operations employ many organic farming practices. This is in large part due to the preferences of fresh milk consumers for organic production systems, especially pasture feeding. A recent study (van Asselt et al., Reference Van Asselt, Capuano and van der Fels-Klerx2015) on dairy farming in the Netherlands concluded that ‘raw organic milk is more sustainable than pasteurized organic milk’ and furthermore that ‘it is also more sustainable than pasteurized conventional milk due to a higher revenue’. Where policy supports production and trade in fresh milk, more farmers are likely to enter the business of producing fresh milk. Thus, more pasture-based dairy farms would contribute to more land area under sustainable soil fertility management.

As a case study, the state of New Jersey illustrates the impact of food policy on soil fertility. By law New Jersey currently prohibits distribution of raw milk by dairy farmers. However, there is no law against sales of raw vegetables directly from farms. Consequently, New Jersey has numerous small vegetable farms; but for dairy farming, there is no practical legal avenue for direct marketing of fresh milk. Consequently, fresh milk drinkers source this special food choice from neighboring states where sales are permitted. An estimated $95 million in revenue leaves New Jersey annually, which goes to support out-of-state fresh milk dairy farms (Heckman, Reference Heckman2014) rather than local farms.

Where New Jersey once had thousands of small dairy farms spread across the Garden State, <70 remain. Among states in the Northeast USA, New Jersey obtains a relatively small (12%) percentage of its agricultural revenue from livestock. Thus, looking at New Jersey as an example, it may be argued that the legal status of milk policy nearly precludes the viability of small dairy operations and the sustainability of local well-distributed soil fertility ecosystems that would naturally follow the dairy cow.

Summary

The raw milk movement has been associated with the organic farming movement since its inception. Walter Northbourne, the first person to write about organic as a system of farming, correctly characterized the emerging problems not only of agriculture, but of fresh food systems. He explained that just as industrialization of farming lead to erosion and destruction of soil on a massive scale, the ‘vast distributing concerns’, ‘specialization’ and the phenomenon of ‘infection in bulk’ created the need for milk pasteurization, and that this heat process degraded the quality of a fresh whole food.

The organic dairy farming community in ‘refusing to push the cows’ is pursuing natural alternatives to industrial confinement production by emphasizing the feeding of dairy animals outside, in sunshine and on pastures grown on fertile soils. In this system, organic farmers are willing to accept lower productivity for healthier cows, higher quality milk, economic sustainability and happy feedback from fresh milk consumers. Agricultural universities and the Cooperative Extension System reluctantly joined in with research and teaching of organic food and farming systems as they slowly became accepted and moved into the mainstream. These same institutions have an opportunity to become a positive force in reinventing dairy farming and restoring the ecology of this traditional food and farming system.