Intersections of Science and Culture: Part 1

Advances in the interdisciplinary knowledge base raised by the three authors below, particularly for immunology, nutrition, and human health, highlight pro-pasteurization ‘blind spots’ (‘downsides’ to pasteurizing the milk microbiota) revealed in the intersections of science and culture as presented in these three very readable and engrossing books.

• Rodney Dietert (2016) [1] The Human Superorganism: How the Microbiome Is Revolutionizing the Pursuit of a Healthy Life

• Marty Makary (2024) [2]
  Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health

• Forrest Maready (2025) [3]
  The Germ in the Dairy Pail: The 200-Year War on the World’s Most Amazing Food-Milk.

One brief perspective of their intersecting visions for transforming public health in the 21st century· follows, with later expansion.

Dietert (2016):

• replace highly processed foods with nutritionally dense, microbially rich whole foods;

• ‘seed and feed’ the gut microbiota;

• reverse epidemic of noncommunicable disease

· Makary (2024):

• recognize ‘blind spots’ (entrenched dogmas) that compromise public health, as
  the assumption of no ‘downside’ to antibiotics … except ‘carpetbombing the microbiota’;

• embrace conflicting evidence rather than suppress evidence for building trust

· Maready(2025):

• root causes of ‘milk problem’ included industrialization of dairy production,
  adulteration of ‘city milk’ (swill milk), fear and sensationalism of ‘war on microbes’, and
  unscrupulous promotion of artificial infant formula starting in the 1870s;

• ADULTERATED milk IS inherently dangerous, particularly for infants; physicians and scientists challenging dogma silenced;

• demonstrated benefits of high quality raw milk produced using stringent standards for
  pastured cows (as Certified Milk Program, 1893 onwards, commercial scale ~25,000 gallons daily by 1908), standards comparable to Raw Milk Institute (2011 to present)

• certified raw milk diet from pastured cows reduced infant mortality (1905 reference), reduced digestive disturbances compared to pasteurized milk (1909 reference), only effective treatment promoting recovery from chronic debilitating diseases, including colitis and tuberculosis (e.g., John D. Rockefeller, Upton Sinclair; 1910 reference)

To expand, The Human Superorganism was described by a book reviewer in 2016 as ‘fascinating, authoritative, and revolutionary,’ but the work is truely remarkable in its readability and veracity even in this past decade of unimagined advances in knowlege that microbes contribute to health. Author Rodney Dietert, a Cornell University Emeritus Professor, described Homo sapiens as a superorganism or holobiont, existing as a ‘mostly microbial’ hybrid, a conglomerate, an ecosystem, a powerful ecological network of multiple species. Even though plants and animals and microbes were assigned Genus and species names as single, complete entities, now they are understood to be superorganisms. Animals and plants not only co-exist with their microbial partners, but are ‘incomplete’ without them. Mutually beneficial and synergistic interactions maintain superorganism health. When key components of the ecosystem are missing or disturbed or replaced, superorganism health can be compromised transiently or long-term.

 Dietert proposed ‘paradigm-shifting arguments’ in his 2016 book and his later writings that challenge two fundamental beliefs or dogmas largely based in 19th century science: 1) ‘Humans are better off as pure organisms free of foreign microbes’; and 2) ‘the human genome is the key to future medical advances’. In essence, the microbiota revolution of the 21st century revealed Homo sapiens as incomplete without its microbiota, its microbial partners in health [4,5].

 Consider how overemphasis of germ theory from the 19th century has been ‘weaponized’, with increasing industrialization and consolidation of agriculture continuing into this decade, promoting microbially impoverished, highly-processed, nutrient-poor foods for an increasingly unhealthy population overcome with inflammatory and metabolic diseases. Ancient nutrient-dense foods (including milk complete with its natural microbiota that have supported human health for over ten millennia) have largely been replaced with highly processed foods in the typical US diet, to the detriment of public health. Dietert’s book called for a ‘revolution in public health’ that begins with a return to a diet dominated by nutrient dense, microbially rich whole foods to reverse the epidemic of non-communicable disease and begin building and sustaining diverse and resilient microbial partners that can withstand challenges by pathogens and other stressors.

Professor Dietert expanded his work on interactions of human superorganisms in a series of manuscripts in diverse journals, including Nourishing the Human Holobiont to Reduce the Risk of Non-Communicable Dieases: A Cow’s Milk Evidence Map Example in 2022. Highlights from that work follow.

• benefits AND risks exist for BOTH raw and pasteurized milks;

• downsides of pasteurizing are loss of benefits of bioactive components in milk, including microbiota, and loss of protection against allergy, asthma, respiratory diseases, and the world’s number one cause of human death, non-communicable diseases;

• outdated dogmas problematic for regulating 21st century raw milks 

 Dietert’s body of work intersects with that of Dr. Marty Makary, a physician and Commissioner of the Food and Drug Administration and author of Blind Spots [2]. In particular, Makary’s Chapter 3 describes the medical community’s ‘blind spot’ or dogma that there was no ‘downside’ to antibiotics … except ‘carpet-bombing the microbiota’. Consider also the common belief or dogma in the media and among some scientists that there is no ‘downside’ to pasteurizing (carpet-bombing) the milk microbiota.

 Similarly, both books by Makary and Forrest Maready emphasized patterns of clashes of culture with science. Medical and public health communities were complicit in suppression of scientific evidence conflicting with established and entrenched dogma. One ‘key’ example in both books is decades of suppression of evidence falsifying Ancel Key’s ‘lipid hypothesis’ unfortunately marketed as ‘fact’ that drove distorted government policies, now acknowledged as harmful to public health, despite dissent.

 The extensive historical research that Maready documents in The Germ in the Dairy Pail [3] points to converging crises related to milk in 1860s and beyond:  

i)                    industrialization of dairy production with confinement of malnourished urban cows more susceptible to overcrowding diseases and motivating adulteration of ‘swill milk’;

ii)                  overcrowding of urban humans lacking clean water, sanitation, and unadulterated nutritious foods;

iii)                sensationalism of the war on microbes, fueling a culture of germophobia and fear of milk microbes; and

iv)                aggressive and unscrupulous marketing of artificial infant formula in the late 1870s and onward as superior to raw milks, ‘purported to replicate mother’s milk through scientific formulation’.

In his book, Maready describes in many short chapters a long history of milk pasteurization mandates focused primarily on the 19th and 20th centuries. His perspective is that mandates were based on fear and economics, not scientific evidence of public health benefits and risks. Unfortunately, then as now, Maready noted that dissenting views of physicians and researchers were ignored in the strongly pro-pasteurization culture, much as Dr. Makary [2] noted suppression of warnings about the downsides of antibiotics in the medical community. A 21st -century risk analyst would likely attribute pro-pasteurization policies as based on ‘risk perceptions’, not risk estimates based on the available evidence for benefits and harms.

Maready’s research into early writings on the 200-year war on milk point to a ‘blind spot’ still masked in the 21st century:  pasteurization of milk began as a ‘convenient technological solution to industrialization’ of dairy practices in 19th century distilleries in NY City and other urban centers. Further, pasteurization was promoted by decades of decisions that appeared to put economics and politics before public health and animal health. Maready points out the ‘downsides’ of pasteurization: loss of benefit to humans, cows, and pasture-based dairies.

 Substantial evidence from historical documents and the work of medical professionals in the 19th and 20th centuries that the ‘milk problem’ was caused by 19th century adulterated milk (‘swill milk’) from unhealthy diseased confined cows fed malnutritious distillery waste, diluted with contaminated water to stretch profits, and amended with whitening agents (chalk, plaster of Paris, flour) to mask off colors. ‘Swill milk’ was ‘inherently dangerous’. Maready emphasizes the misconception or deception that ‘country milk’ or raw milk from healthy pastured cows was ‘inherently dangerous’.

 Pro-pasteurization regulations ignored production risks in favor of an endproduct kill-step (pasteurization), with losses in nutritional, developmental, and immunological benefits to both humans and cows. Industrial production (concentrated confined herds fed predominantly grains) and processing of milk (primarily pasteurization and homogenization) destroy the inherently beneficial nature of the milk microbiota and its ‘inimitable plethora’ of bioactive components that promote growth and development of healthy gut, respiratory, and neural systems while protecting against acute infectious and chronic non-communicable diseases. In addition to the references provided by Maready, check out these recent studies [6–11].

 Public fear, media sensationalism, and government overreach in the 19th and 20th centuries set the stage for today’s challenges to food freedom (1, p 136). Government responses often missed the mark, failing to address the root causes of tuberculosis and mortality (industrialized processes, overcrowding, poor nutrition and sanitation, inadequate human and veterinary health care) and instead imposed mandatory pasteurization of milk rather than improving and monitoring urban production practices (1, p 146).

 Maready described the Certified Milk Program founded by Dr. Henry Coit in 1892 and the intellectual and political climate that silenced dissenting medical views that revealed ‘downsides’ to pasteurization. Noted below are 13 bullets emphasizing remarkably fortelling quotes from physicians and scientists of the 19th and early 20th centuries that resonate with deeper 21st century knowledge from recent studies of the mammalian milk microbiota and its benefits and risks. They also resonate with the ‘pro-pasteurization blind spot’ that there is no ‘downside’ to pasteurizing milk (other than carpet-bombing the milk microbiota and other bioactive, thermally sensitive components of milk).

         i.            In the 1860s, the invention of microscopes that revealed microbes in milk provided a new lens to view food. Rural dairy farmers viewed raw milk from traditional grass-fed operations as needing no remediation [pasteurization] that masked quality issues of urban milk from confined cows and extend marketability of ‘city milk’ or ‘swill milk’. Yet, traditional farms were subject to unfair and burdensome regulations that addressed problems endemic to urban production systems.

Public discourse from physicians in this period included statements consistent with rural dairy farmers’ perspective:  ‘health regulation mistakenly conflates pure farm-produced [raw] milk with contaminated [adulterated] ‘swill milk’, unjustly burdening rural producers’; and ‘Heat sufficient to destroy all living organisms must necessarily alter the vital qualities of the milk itself. We risk eliminating both the harmful and the beneficial, with consequences we cannot yet predict.’ (1, p 107).

Then as now, regulatory overreach continues, as does the common misconception [misinformation or disinformation] that raw milk is ‘inherently dangerous’ rather than ‘made dangerous by recent industrial practices producing it’ (1, p 107).

The fundamental irony was unacknowledged in this period: rather than address ‘root cause’ of contamination (industrialized production practices, overcrowding, confinement, unnatural diets and adulteration), society embraced technological fixes that treated symptoms, perpetuating underlying problems (1, p 108).

       ii.            In 1878-1879, researchers Dr. Franz Soxlet and Claude Bernard noted that: ‘heating milk beyond 60° C (140° F) significantly impairs its enzyme content, altering its digestive properties’; ‘alternations from heat may profoundly affect nutritional properties of [milk’s] natural substances, compromising their physiological benefits’; ‘infants fed heated milk exhibited signs of malnutrition’; and raw milk promoted weight gain and development in laboratory animals over pasteurized milk (1, p 110-111).

     iii.            In 1893, NJ physician Dr. Henry L. Coit stated that the ‘certification of milk by medical commissions [Certified Milk Program] offers the best solution to our milk problem. Not through heat, which destroys vital elements, but through cleanliness and careful monitoring’ (1, p 138). Certification required compliance with stringent requirements for pastured cows, including tuberculosis testing, regular veterinary and worker inspections, rapid cooling, and microbial standards for bacterial indicators of proper hygienic processes (1, pp 138-139).

     iv.            In 1896, microbiologist Dr. Theobald Smith stated to the American Public Health Association: ‘Milk is not inherently dangerous. It is the disease borne within it, transmissible from infected cows to humans, that constitutes the real threat. Proper testing and segregation of diseased animals can restore milk’s status as a safe and wholesome food’. Maready notes that Dr. Smith’s voice was drowned out by commercial interests (pasteurization equipment manufacturers, infant formula producers, large urban dairy/distillery operations) and sensationalism in the media generating fear and vilification of milk (1, p 148).

       v.            In 1905, director of the Hygienic Laboratory of the Public Health Service Dr. Milton Rosenau noted that the Certified Milk Program ‘constitutes one of the most practical demonstrations in preventive medicine, illustrating the high sanitary standard attainable’, evidenced by reduced infant mortality (1, p 155). Further, Florida physician Dr. Charles Sanford Porter reported in a medical journal ‘the complete recovery of patients [at his sanitarium] suffering from chronic dyspepsia, colitis, and even tuberculosis through this regimen [certified raw milk diet]’ (1, p157).

     vi.            In 1906, physician-in-chief at NY Babies Hospital Dr. Emmett Holt warned that artificial infant formula was ‘inferior to natural methods [breastfeeding, wetnursing]. We must be cautious about embracing industrial solutions [artificial infant formula] without fully understanding their long-term consequences (1, pp 158-159).

Multiple studies demonstrate statistically significant loss of benefits of the ‘inimitable plethora’ of bioactives in raw milk [9,12] for infants fed pasteurized donor milk or artificial infant formulas [13].

   vii.            In 1907, a colleague of Louis Pasteur’s at the Pasteur Institute, Nobel laureate Elie Metchnikoff, wrote ‘the intestinal flora [microbiota] exerts a profound influence on our well-being that has been entirely overlooked,’ reflecting a profound shift towards a more nuanced and holistic perspective on germ theory (1, p 156).

Maready points readers to Pasteur’s obituary in 1895 that highlighted his contributions to germ theory but omitted milk pasteurization as a significant contribution to science. Maready laments that Pasteur, whose career was devoted to advancing understanding of fermentation and microbial life, was ten years later associated with indiscriminately sterilizing microbes in milk (1, p 163).

Scientists in the 21st century continue to follow Metchnikoff’s work, revisiting germ theory and the need for a paradigm shift towards a microbial theory of health that does not center on pathogens as ‘germs’ that will kill us (culture of germophobia) but incorporates beneficial microbes and host-microbiota-pathogen effects [14,15].

 viii.            In 1907, NJ physician Dr. Henry Coit testified that the proposed Chicago ordinance mandating pasteurization of milk was a rejection of a ‘proven solution [Certified Milk Programs] in favor of an industrial process that fundamentally alters a natural food. Certification addresses the source of contamination rather than attempting to correct it after the fact’ (1, pp 157-158).

     ix.            By 1908, despite higher production costs for certified milk, certified dairies operating at commercial scale in many US cities produced ~25,000 gallons daily for a ‘growing clientele of physicians, hospitals, and health-conscious families’ (1, p 156).

Clearly, the assumption that all raw milk was ‘inherently dangerous’ was unfounded in 1908, yet this assumption continues well into 2025. The words of risk analysis that apply are consistent NOT with ‘risk’ estimated using established frameworks and evidence-based models, but ‘risk perception’ based on

       x.            In 1909, Cornell Medical College physician Dr. Joseph Winters reported that ‘infants fed raw certified milk [from pastured cows] gained weight more rapidly and suffered fewer digestive disturbances than those receiving pasteurized milk (1, p 159).

·This statement is consistent with multiple studies demonstrating that benefits are lost when infants are fed pasteurized donor breastmilk rather than raw donor breastmilk or mother’s own milk [6,16–20].

     xi.            In 1910, two eminent citizens embraced the certified raw milk diet, 70-year old oil magnate John D. Rockefeller in Cleveland and writer Upton Sinclair (The Jungle, 1905-1906; The Raw Food Table, 1911) in NY City. Both had suffered chronic debilitating digestive disease and fatigue that had not responded to medical treatments until certified raw milk diet was prescribed.

   xii.            In 1912, Dr. Charles North, cofounder of the American Association of Medical Milk Commissions or AAMMC, lamented abandonment of proven preventative approach of production using the Certified Milk Program, in favor of pasteurization, indiscriminately killing all bacteria. In reality, this policy did not arise from scientific progress, but ‘industrial convenience masquerading as public health’ protection (1, p 158).

 xiii.            In 1921, Columbia University’s Dr. Alfred Hess wrote that the ‘biological relationship between nutrition and health suggests that we must reconsider overly simplistic views of microbes [as germs that will kill us], understanding their potential to contribute positively to human physiology’ (1, p 160). The nuanced reality of milkborne microbes with beneficial or harmful effects was not understood then or now. ‘Microbes were feared as monstrous deadly invaders, and sensationalism in a culture of germophobia seems to outpace scientific understanding’ (1, p 102).

These statements are consistent with Cornell Emeritus Professor Rodney Dietert’s understanding that microbes in our diet and in our bodies are actually more likely to be our partners in health [1,4,5,21,22].

Beginning in the 1880s, voices of dissent, including well-respected medical professionals and scientists and John D. Rockefeller, Upton Sinclair, and others who benefitted from the certified raw milk diet, recognized the distinction between milk produced by healthy pastured cows and that produce by confined diseased cows fed unnatural diets. Currently, informed consumers and the Raw Milk Institute (https://www.rawmilkinstitute.org/updates/two-types-of-raw-milk) recognize these two distinct types of milk, one produced for direct human consumption as raw milk, the other ‘pre-pasteurized milk’ NOT produced according to farmer training, guidelines, and common standards essential for safe high quality milk compete with its natural microbiota (https://www.rawmilkinstitute.org/common-standards).

The root cause of milkborne disease in the !9th and 20th centuries was not the inherent nature of raw milk from well-managed pastured herds, but the adulterated nature of raw milk from stressed animals produced by industrialized processes in confinement and abuse. As Maready points out, ‘science has evolved, but policy has not caught up ([1], p 213).

Deliberation of past and current evidence is merited regarding the revealing truths about the Medical Milk Commissions that oversaw Certified Raw Milk Programs [23–25] that produced safe and wholesome raw milk from pastured cows for decades. The current training, guidelines, and standards provided by the Raw Milk Institute (https://www.rawmilkinstitute.org/about-raw-milk) are consistent with most aspects of the Certified Milk Programs.

References

1.           Dietert, R. The Human Superorganism: How the Microbiome Is Revolutionizing the Pursuit of a Healthy Life; Dutton: New York, New York, 2016;

2.           Makary, M. Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health; Bloomsbury Publishing, 2024;

3.           Maready, F. The Germ in the Dairy Pail: The 200-Year War on the World’s Most Amazing Food-Milk; Feels Like Fire: Wilmington, NC USA, 2025;

4.           Dietert, R.R. A Focus on Microbiome Completeness and Optimized Colonization Resistance in Neonatology. Neoreviews 2018, 19, e78–e88, doi:10.1542/neo.19-2-e78.

5.           Dietert, R.R.; Dietert, J.M. Twentieth Century Dogmas Prevent Sustainable Healthcare. Am J Biomed Sci Res 2021, 13, 409–417, doi:10.34297/AJBSR.2021.13.001890.

6.           Coleman, M.E.; Dietert, R.R.; North, D.W. Recent Evidence for Benefit-Risk Analysis of the Breastmilk Ecosystem 2021.

7.           Coleman, M.E.; North, D.W. Revisioning Small Family Dairy Farms That Apply One Health Approaches. 2023, 5.

8.           Dietert, R.R.; Coleman, M.E.; North, D.W.; Stephenson, M.M. Nourishing the Human Holobiont to Reduce the Risk of Non-Communicable Diseases: A Cow’s Milk Evidence Map Example. Applied Microbiology 2022, 2, 25–52, doi:10.3390/applmicrobiol2010003.

9.           Fernández, L.; Ruiz, L.; Jara, J.; Orgaz, B.; Rodríguez, J.M. Strategies for the Preservation, Restoration and Modulation of the Human Milk Microbiota. Implications for Human Milk Banks and Neonatal Intensive Care Units. Frontiers in Microbiology 2018, 9, 2676.

10.        Gallo, V.; Arienzo, A.; Tomassetti, F.; Antonini, G. Milk Bioactive Compounds and Gut Microbiota Modulation: The Role of Whey Proteins and Milk Oligosaccharides. Foods 2024, 13, 907, doi:10.3390/foods13060907.

11.        Stephenson, M.M.; Coleman, M.E.; Azzolina, N.A. Trends in Burdens of Disease by Transmission Source (USA, 2005–2020) and Hazard Identification for Foods: Focus on Milkborne Disease. J Epidemiol Glob Health 2024, doi:10.1007/s44197-024-00216-6.

12.        Coleman, M.E. Deliberating the Scientific Evidence Base for Influenza Transmission to Raw Milk Consumers. Risk Analysis 2025, doi:https://doi.org/10.1111/risa.70077.

13.        Coleman, M.E.; North, D.W.; Dietert, R.R.; Stephenson, M.M. Examining Evidence of Benefits and Risks for Pasteurizing Donor Breastmilk. Applied Microbiology 2021, 1, 408–425, doi:10.3390/applmicrobiol1030027.

14.        Scott, E.A.; Bruning, E.; Nims, R.W.; Rubino, J.R.; Ijaz, M.K. A 21st Century View of Infection Control in Everyday Settings: Moving from the Germ Theory of Disease to the Microbial Theory of Health. American Journal of Infection Control 2020, 48, 1387–1392, doi:10.1016/j.ajic.2020.05.012.

15.        Carlsson, F.; Råberg, L. The Germ Theory Revisited: A Noncentric View on Infection Outcome. Proceedings of the National Academy of Sciences 2024, 121, e2319605121, doi:10.1073/pnas.2319605121.

16.        Briere, C.-E.; Gomez, J. Fresh Parent’s Own Milk for Preterm Infants: Barriers and Future Opportunities. Nutrients 2024, 16, 362, doi:10.3390/nu16030362.

17.        Chen, J.; Wesemael, A.J. van; Denswil, N.P.; Niemarkt, H.J.; Goudoever, J.B. van; Muncan, V.; Meij, T.G.J. de; Akker, C.H.P. van den Impact of Mother’s Own Milk vs. Donor Human Milk on Gut Microbiota Colonization in Preterm Infants: A Systematic Review. mrr 2024, 4, N/A-N/A, doi:10.20517/mrr.2024.44.

18.        Dombrowska-Pali, A.; Wiktorczyk-Kapischke, N.; Chrustek, A.; Olszewska-Słonina, D.; Gospodarek-Komkowska, E.; Socha, M.W. Human Milk Microbiome-A Review of Scientific Reports. Nutrients 2024, 16, 1420, doi:10.3390/nu16101420.

19.        Lund, A.-M.; Löfqvist, C.; Pivodic, A.; Lundgren, P.; Hård, A.-L.; Hellström, A.; Hansen-Pupp, I. Unpasteurised Maternal Breast Milk Is Positively Associated with Growth Outcomes in Extremely Preterm Infants. Acta Paediatrica 2020, 109, 1138–1147, doi:10.1111/apa.15102.

20.        Pütz, E.; Ascherl, R.; Wendt, T.; Thome, U.H.; Gebauer, C.; Genuneit, J.; Siziba, L.P. The Association of Different Types of Human Milk with Bronchopulmonary Dysplasia in Preterm Infants. Front. Nutr. 2024, 11, doi:10.3389/fnut.2024.1408033.

21.        Dietert, R.R. Safety and Risk Assessment for the Human Superorganism. Human and Ecological Risk Assessment: An International Journal 2017, 23, 1819–1829, doi:10.1080/10807039.2017.1356683.

22.        Dietert, R.R. Microbiome First Approaches to Rescue Public Health and Reduce Human Suffering. Biomedicines 2021, 9, 1581, doi:10.3390/biomedicines9111581.

23.        Brown, J.H. A Critical Discussion of Some Methods and Standards for Certified Milk. Am J Public Health Nations Health 1938, 28, 1053–1058, doi:10.2105/AJPH.28.9.1053.

24.        Foord, J.A. The Production of Certified Milk. The New England Journal of Medicine 1913, doi:10.1056/NEJM191304241681704.

25.        Alexander, A. Udder Diseases of the Cow and Related Subjects; RG Badger, 1929.