Authorities in Germany have, at last, concluded that bean sprouts were the causative agent in the recent outbreak of enterotoxigenic E. Coli they’ve been having. And the question does seem to arise: why did this take so long?

According to reports on NPR and elsewhere, the biggest problem may have been an over reliance on hard(ish) direct science, and a disinclination to rely on indirect methods. The German equivalent to the CDC is the Robert Koch Institute, named after a famed German physician and microbiologist, the man who isolated the causative agents of anthrax and tuberculosis (bacillus anthracis and mycobacterium tuberculosis, respectively). The man who put forth what are still called Koch’s postulates, which are guidelines to help decide what bacteria cause which diseases. And alas, the Koch Institute took them perhaps a bit too seriously. They were looking for produce from which they could isolate the causative bacteria, and that proved somewhat problematic, since there were either too many types of produce, or not enough bacteria on them. So they dithered, and named a few vegetable which, in retrospect, had nothing to do with the outbreak, and ignored the epidemiological evidence, which apparently pointed pretty unambiguously to bean sprouts as the culprit (the risk ratio, a measure of the likelihood that a particular exposure caused a disease, was something like 9:1; while that’s not “proof”, in the courtroom sense of the word, it’s enough, in epidemiology, to start getting the bean sprouts out of the stores).

In an outbreak, there are three competing priorities, in general: be fast, be thorough, and be right. As with other fields where these are desirable, you can generally have two, depending on the level of evidence you desire. Thing is, epidemiology is the science which points you in the right direction. It can be wrong, but the sources of wrong are pretty well understood, and easy enough to avoid if you don’t get sloppy. The folks at the Koch Institute weren’t sloppy, but they were neither fast, nor right (in the event, they eventually became right, but it took awhile, and they had a couple of false cucumbers, I mean starts). I don’t know what the issue was at the institute-it smacks of internal politics, in which perhaps the microbiologists were accorded more respect than the epidemiologists, but I hope that someone finds out, and corrects, the said politics. Europe can’t afford another flub set like this in the face of the next outbreak. And there’s always, *always* a next outbreak. The CDC and the USDA actually have a good process for investigating these kinds of outbreaks, since we’ve had so many of them (we practically invented enterotoxigenic E. coli, with the O157:H7 strain). I wonder if someone from there is even now on their way to a nice German “vacation”. My college roommate Greg Armstrong now works for CDC, and was involved in the early outbreak investigations of enterotoxigenic E. coli (aka Shiga-toxigenic E. coli) as part of the USDA E. coli O157:H7 STRIKE FORCE. I made fun of him about it at the time (“someone has diarrhea! Launch the black helicopters!”), but it’s important work. Bugs are smart, and as I heard it put recently, one smart person is not necessarily smarter than billions of dumb bacteria. We’re going to see more outbreaks, of this and other types, as bacteria mutate, learn ways around our antibiotics, and generally keep trying to kill us, not because they want us dead in the long run, but because they want us as food in the short run, and that tends to make some of us dead regardless. We need smart people to keep working on outsmarting the bacteria; if we ever get the idea that infectious diseases are done for, I promise a revelatory plague we won’t soon forget.