What happens when free speech meets public health efforts to regulate commercial enterprises that potentially raise health and safety risks? In the latest issue of Public Health Reports, September/October 2014, George Washington University assistant research professor Ms. Stephanie D. David, explores the question, using the case of raw milk sales to illustrate the issues that can arise for public health policy-making and enforcement.

With raw milk advocates continuing to push for state laws easing access to raw milk, health professionals (e.g., the American Academy of Pediatrics), public health officials, and foodborne illness victims continue to warn of its dangers. From 1998 to 2011, the United States experienced at least 148 outbreaks from raw milk and raw milk products, resulting in 2,384 illnesses, 284 hospitalizations, and two deaths. One recent study suggests that outbreak numbers alone understate the number of individuals who fall victim to foodborne illness from drinking raw milk.

With regard to the future of raw milk, public health officials are between a rock and a hard place. In states where consumers demand it and legislators support it, there appear to be few options to ensure the safety of individuals (most concernedly children) who consume a product that is known to cause significant foodborne illness. Advertising restrictions and compelled warning labels provide two interventions to help limit sales and inform consumers of the risk in those states where raw milk is legal. However, if public health authorities lose these tools due to First Amendment complications, public health will need to find other strategies to help keep consumers informed and safe from the potential risks of drinking raw milk.

This week’s PHR feature article, Law and the Public’s Health: Raw Milk and the First Amendment: Implications for Public Health Policy and Practice, is available open access online through September 25. For full access to all current content, visit the Public Health Reports website to subscribe.