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Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age

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Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age

I had a nagging toothache recently, and it led to an even more painful revelation.

If you X-rayed the state of oral health care in the United States, particularly for people 65 and older, the picture would be full of cavities.

“It’s probably worse than you can even imagine,” said Elizabeth Mertz, a UC San Francisco professor and Healthforce Center researcher who studies barriers to dental care for seniors.

Mertz once referred to the snaggletoothed, gap-filled oral health care system — which isn’t really a system at all — as “a mess.”

But let me get back to my toothache, while I reach for some painkiller. It had been bothering me for a couple of weeks, so I went to see my dentist, hoping for the best and preparing for the worst, having had two extractions in less than two years.

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Let’s make it a trifecta.

My dentist said a molar needed to be yanked because of a cellular breakdown called resorption, and a periodontist in his office recommended a bone graft and probably an implant. The whole process would take several months and cost roughly the price of a swell vacation.

I’m lucky to have a great dentist and dental coverage through my employer, but as anyone with a private plan knows, dental insurance can barely be called insurance. It’s fine for cleanings and basic preventive routines. But for more complicated and expensive procedures — which multiply as you age — you can be on the hook for half the cost, if you’re covered at all, with annual payout caps in the $1,500 range.

“The No. 1 reason for delayed dental care,” said Mertz, “is out-of-pocket costs.”

So I wondered if cost-wise, it would be better to dump my medical and dental coverage and switch to a Medicare plan that costs extra — Medicare Advantage — but includes dental care options. Almost in unison, my two dentists advised against that because Medicare supplemental plans can be so limited.

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Sorting it all out can be confusing and time-consuming, and nobody warns you in advance that aging itself is a job, the benefits are lousy, and the specialty care you’ll need most — dental, vision, hearing and long-term care — are not covered in the basic package. It’s as if Medicare was designed by pranksters, and we’re paying the price now as the percentage of the 65-and-up population explodes.

So what are people supposed to do as they get older and their teeth get looser?

A retired friend told me that she and her husband don’t have dental insurance because it costs too much and covers too little, and it turns out they’re not alone. By some estimates, half of U.S. residents 65 and older have no dental insurance.

That’s actually not a bad option, said Mertz, given the cost of insurance premiums and co-pays, along with the caps. And even if you’ve got insurance, a lot of dentists don’t accept it because the reimbursements have stagnated as their costs have spiked.

But without insurance, a lot of people simply don’t go to the dentist until they have to, and that can be dangerous.

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“Dental problems are very clearly associated with diabetes,” as well as heart problems and other health issues, said Paul Glassman, associate dean of the California Northstate University dentistry school.

There is one other option, and Mertz referred to it as dental tourism, saying that Mexico and Costa Rica are popular destinations for U.S. residents.

“You can get a week’s vacation and dental work and still come out ahead of what you’d be paying in the U.S.,” she said.

Tijuana dentist Dr. Oscar Ceballos told me that roughly 80% of his patients are from north of the border, and come from as far away as Florida, Wisconsin and Alaska. He has patients in their 80s and 90s who have been returning for years because in the U.S. their insurance was expensive, the coverage was limited and out-of-pocket expenses were unaffordable.

“For example, a dental implant in California is around $3,000-$5,000,” Ceballos said. At his office, depending on the specifics, the same service “is like $1,500 to $2,500.” The cost is lower because personnel, office rent and other overhead costs are cheaper than in the U.S., Ceballos said.

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As we spoke by phone, Ceballos peeked into his waiting room and said three patients were from the U.S. He handed his cellphone to one of them, San Diegan John Lane, who said he’s been going south of the border for nine years.

“The primary reason is the quality of the care,” said Lane, who told me he refers to himself as 39, “with almost 40 years of additional” time on the clock.

Ceballos is “conscientious and he has facilities that are as clean and sterile and as medically up to date as anything you’d find in the U.S.,” said Lane, who had driven his wife down from San Diego for a new crown.

“The cost is 50% less than what it would be in the U.S.,” said Lane, and sometimes the savings is even greater than that.

Come this summer, Lane may be seeing even more Californians in Ceballos’ waiting room.

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“Proposed funding cuts to the Medi-Cal Dental program would have devastating impacts on our state’s most vulnerable residents,” said dentist Robert Hanlon, president of the California Dental Assn.

Dental student Somkene Okwuego smiles after completing her work on patient Jimmy Stewart, 83, who receives affordable dental work at the Ostrow School of Dentistry of USC on the USC campus in Los Angeles on February 26, 2026.

(Genaro Molina / Los Angeles Times)

Under Proposition 56’s tobacco tax in 2016, supplemental reimbursements to dentists have been in place, but those increases could be wiped out under a budget-cutting proposal. Only about 40% of the state’s dentists accept Medi-Cal payments as it is, and Hanlon told me a CDA survey indicates that half would stop accepting Medi-Cal patients and many others will accept fewer patients.

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“It’s appalling that when the cost of providing healthcare is at an all-time high, the state is considering cutting program funding back to 1990s levels,” Hanlon said. “These cuts … will force patients to forgo or delay basic dental care, driving completely preventable emergencies into already overcrowded emergency departments.”

Somkene Okwuego, who as a child in South L.A. was occasionally a patient at USC’s Herman Ostrow School of Dentistry clinic, will graduate from the school in just a few months.

I first wrote about Okwuego three years ago, after she got an undergrad degree in gerontology, and she told me a few days ago that many of her dental patients are elderly and have Medi-Cal or no insurance at all. She has also worked at a Skid Row dental clinic, and plans after graduation to work at a clinic where dental care is free or discounted.

Okwuego said “fixing the smiles” of her patients is a privilege and boosts their self-image, which can help “when they’re trying to get jobs.” When I dropped by to see her Thursday, she was with 83-year-old patient Jimmy Stewart.

Stewart, an Army veteran, told me he had trouble getting dental care at the VA and had gone years without seeing a dentist before a friend recommended the Ostrow clinic. He said he’s had extractions and top-quality restorative care at USC, with the work covered by his Medi-Cal insurance.

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I told Stewart there could be some Medi-Cal cuts in the works this summer.

“I’d be screwed,” he said.

Him and a lot of other people.

steve.lopez@latimes.com

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NASA’s Artemis II Is the First Crewed Moon Mission Since 1972. Why Are We Going Back?

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NASA’s Artemis II Is the First Crewed Moon Mission Since 1972. Why Are We Going Back?

An animated 3-D model of the moon, shown on a black background.

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A 3-D model of the moon with the near side in view. It reads: This is the side of the moon we see from Earth

In the first era of moon exploration, NASA and the Soviet Union focused on the near side of the moon, where there was direct radio communication with Earth.

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A 3-D model of the moon with the near side in view and circles for landing and crash sites, including Luna 9, 1966 (U.S.S.R.) and Apollo 11 and Apollo 12 (both in 1969, U.S.A).

Today, NASA and other space agencies, like those of China and India, are intrigued by the far side of the moon, which is out of view from Earth…

A 3-D model of the moon with the far side in view and circles for landing and crash sites, including Chang’e 4, 2019 (China) and Chang’e 6, 2024 (China).

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…as well as the polar regions.

A 3-D model of the moon with the south pole in view and circles for landing and crash sites, including the same Chang’e missions and also Chandrayaan-3, 2023 (India).

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A new lunar race is now underway: The United States wants to land humans back on the moon by 2028, two years ahead of China. But the motivations are somewhat different from what put men on its surface 50 years ago.

There is water at the moon’s poles, frozen in the eternal shadows within craters.

Water molecules can be broken apart into hydrogen and oxygen. If countries set up moon bases there, the oxygen could provide breathable air, and hydrogen and oxygen could be used as rocket propellants. Astronauts could also get their drinking water from the moon’s ice. NASA has identified potential landing sites in this area, and China wants to build outposts around the moon’s south pole.

For scientists, the water and other chemicals trapped in the shadowed regions could provide a record of comet and asteroid impacts. Cores drilled from the crater floors could provide a history of the solar system stretching back 4.5 billion years, similar to how ice cores extracted from Greenland and Antarctica tell of Earth’s climate over the past few thousand years.

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Helium-3 could be mined from the lunar soil.

Helium-3, a lighter version of helium, with only one neutron in its nucleus instead of two, is exceedingly rare on Earth. It costs about $9 million a pound, and the biggest source is decayed tritium, a heavy form of hydrogen found in nuclear weapons stockpiles.

The moon could provide much more. The fusion reactions that light up the sun produce helium-3, some of which is propelled throughout the solar system as part of the solar wind that blows outward from the sun. Some of those atoms slam into the moon and become embedded in the lunar soil.

Titanium-rich minerals are more likely to trap helium-3. The rocks on the near side of the moon contain more of these minerals and those locations are believed to be most promising for the mining of helium-3.

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Although concentrations are low, they are still higher than on Earth, whose magnetic field deflects the solar wind around the planet.

Decades in the future, helium-3 could be an ideal fuel for fusion power plants. A more immediate use could be for ultracold refrigerator systems needed for quantum computing.

Animated 3-D model of the moon that shows higher concentrations of helium-3 on the near side of the moon.

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A lunar telescope could be installed in a crater on the far side of the moon.

Over the past century, the Earth has become a noisy place for astronomers wishing to listen to the radio waves that fill the universe. Those waves emanate from glowing gas clouds of hydrogen, auroras of distant planets and fast-spinning neutron stars. But those signals are often drowned out by ubiquitous transmissions of modern society like radio and television shows, cellphone calls and industrial electrical equipment.

The Earth’s ionosphere also blocks long-wavelength radio waves, which would give clues about the very early universe, from reaching ground-based radio telescopes. But on the far side of the moon, all that radio noise from Earth is silenced, unable to pass through 2,000 miles of rock. And the long-wavelength radio waves could also be observed.

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Building a radio telescope in a crater on the moon would take advantage of that natural concave shape. A location near the equator in the middle of the far side could be an ideal listening spot.

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After years of talking about lunar outposts in vague terms for sometime in the indefinite future, NASA recently shifted, putting a continuing U.S. presence on the moon solidly on its road map for the coming decade.

Plans for a moon base would proceed in phases. It would go from regular moon visits to building permanent infrastructure; power and communication systems; vehicles to carry astronauts and cargo across the surface; and possibly nuclear power plants.

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Methodology

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The 3-D model’s base imagery is from NASA’s Moon CGI kit. Data on lunar landing and crash sites was gathered and verified using multiple sources: NASA Space Science Data Coordinated Archive; China National Space Administration; Japanese Space Agency; European Space Agency; Indian Space Research Organization; and the Smithsonian Institution.

To create the time-lapse animation showing the moon’s permanently shadowed areas at the south pole in January 2026, New York Times journalists used a digital elevation model from the Lunar Orbiter Laser Altimeter (LOLA), data from LOLA’s Gridded Data Records (GDRs) and ephemeris sourced from the U.S. Geological Service (USGS) Astropedia.

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Frozen water detections were provided by Shuai Li from the University of Hawaii.

Lunar landing sites for future Artemis missions at the South Pole are from NASA’s update from October 2024.

Helium-3 concentration data was provided by Wenzhe Fa from Peking University, China.

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Diagrams of the lunar radio telescope deployment and radio interference are based on NASA Jet Propulsion Laboratory’s concepts.

This project also used geographic references from the USGS Geologic Atlas of the Moon and the Lunar South Pole Atlas by the Lunar and Planetary Institute.

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Autistic people are more likely to experience suicidal crisis. 988 is changing to serve them better

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Autistic people are more likely to experience suicidal crisis. 988 is changing to serve them better

Free, largely confidential and available 24 hours a day via call, text or online chat, the 988 Lifeline — formerly the National Suicide Prevention Lifeline — is among the most accessible and effective suicide prevention tools in the U.S.

People have contacted the service roughly 25 million times since July 2022, when the previous 10-digit telephone number officially converted to the shorter and more memorable 988. An overwhelming majority of system users in a study commissioned by the agency that oversees the lifeline said they found it helpful and potentially lifesaving.

Yet for one particularly vulnerable population, the decision to reach out can be especially complicated.

Many autistic people require additional time to process verbal information, particularly in stressful or overwhelming situations. If a question is long or laden with metaphoric speech — “feeling blue,” “get it off your chest” — the time required only expands. Some have reported being hung up on when a 988 counselor misinterpreted their silence to mean they’d walked away.

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Others have struggled to make their needs understood, or found that the encounter unfolded in a way that unintentionally caused further harm.

Some years ago, before the launch of the national lifeline’s text service, Rae Waters Haight contacted a text crisis line during a challenging period. The counselor asked a routine question to assess his safety: Was there anything in his house right now that he could use to hurt himself?

Like many autistic people, Haight’s mind interprets language in its most literal sense. Mentally he scanned the rooms of his Carlsbad home, envisioning various objects and the ways they might cause harm. He had no intention of using any of these items, but that wasn’t the question he had been asked.

Yes, he replied.

Haight ended the conversation and headed to bed, telling himself he’d feel better after a night’s sleep. To his alarm, police lights soon flashed through his bedroom window. They were officers dispatched by a concerned counselor who misinterpreted his factually accurate answer as a statement of intent.

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Haight is now part of a growing network of researchers and advocates working to ensure that crisis counselors have the tools they need to help autistic callers, and that autistic people and those who care for them understand what to expect from 988 and similar crisis intervention services before they need to dial.

“Misunderstandings happen frequently between autistic and non-autistic individuals, and this can be difficult at the best of times,” he said. “But during a crisis, the stakes are high.”

Autism spectrum disorder is a neurodevelopmental condition that manifests differently in nearly every person who has it. While the spectrum encompasses a wildly diverse range of behaviors, skills and communication styles, its core traits center on differences in social communication and sensory processing.

For a variety of reasons, autistic people of all ages are significantly more likely than neurotypical peers to experience suicidal thoughts and attempt suicide. In the compressed world of a 988 call, in which both counselor and caller are strangers with little information to go on besides the words they exchange, the potential for miscommunication is high.

“The crisis counselors try to help, but end up kind of just landing wrong.”

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“Autistic people are misunderstood and have difficulty conveying what they’re going through in a way that’s productive,” said Lisa Morgan, founder and co-chair of the Autism and Suicide Prevention Workgroup, a research collective dedicated to the issue. “The crisis counselors try to help, but end up kind of just landing wrong.”

An autistic person’s tone of voice or emotional affect may sound to a non-autistic person as if it doesn’t match the situation’s gravity. Some are mentally soothed by repeating specific words or phrases, a phenomenon known as echolalia, which can be misinterpreted by someone unfamiliar with the trait as mocking or uncooperative.

Many autistic people also have alexithymia, a trait that makes it exceptionally difficult to identify and describe emotions, and have been stymied by questions intended to assess their internal state.

Such misunderstandings can leave the caller feeling frustrated and alone. They can also inadvertently escalate a situation.

According to 988’s confidentiality policy, counselors may share a caller’s information with people outside of the lifeline system if they believe the caller or someone else is at immediate risk of harm, and discussing an alternative safety plan directly with the caller isn’t possible.

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Emergency services are contacted in fewer than 2% of calls, according to Vibrant Emotional Health, the nonprofit organization that administers 988, and most of these dispatches are made with the caller’s consent.

For many autistic people, even a slim prospect of an unwanted encounter with law enforcement or an emergency room is frightening.

“I’ve called 988, I’ve texted 988 before, and my experience was I don’t want to do it anymore.”

“I’ve called 988, I’ve texted 988 before, and my experience was I don’t want to do it anymore. You know why? Because the police will come. And they’ll take me to the hospital,” said Kayla Rodriguez, 29, an autistic woman who lives in the Greater Atlanta area.

Although an emergency room can keep someone safe, many autistic people find its bright lights, incessant noise and unfamiliarity to be more distressing than helpful. A hospitalization during one suicidal period triggered for Rodriguez a yearlong episode of autistic burnout, a form of exhaustion in which the ability to function or tolerate stimuli plummets.

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An encounter with police carries its own risks. Rodriguez was particularly unsettled by the March 1 death of Alex LaMorie, a 25-year-old autistic man who called 911 (not 988) during a suicidal crisis and was shot by responding officers after allegedly failing to drop a knife at their command.

“I wish there were more options to deal with suicidality than just the police and the hospital,” Rodriguez said. “But also, I just wish people would calm down … try to talk to us, try to engage with us and help de-escalate the situation, instead of making it worse.”

Autistic people who have called the crisis line say they don’t expect counselors to be mind readers. But they would like them to be open to adjusting their approach.

“Adapt to the person [calling]. Don’t make the person adapt,” said Andrea Bleifuss, 43, of Portland, Ore., who has worked in mental health care facilities and called the crisis line herself.

The counselors who made her feel truly understood “don’t even have to understand what I’m going through, but they do understand how to relate to someone, how to adapt whatever training they’ve had.”

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Morgan, who is herself autistic, and her research partner Brenna Maddox, a clinical psychologist and co-chair of the workgroup, set out to help the 988 system do just that.

In 2023, they published a guide to help crisis workers assess whether the person they are talking to could be on the autism spectrum. It also offered specific conversation strategies that could improve the call: asking if the person has any special interests; asking clear, short, direct questions; allowing ample time for the person to respond; and being open to the caller’s own suggestions for what works for them. The final page of the guide is a single sheet of tips that crisis workers can print out and hang by their desk.

“An autistic individual may say that spinning quarters is a good distraction technique for them,” reads one tip. “Even if that sounds unusual to the crisis center worker, it is still a valid and acceptable answer.”

The following year, they published a detailed guide for autistic adults on what to expect when contacting 988. This includes the likelihood of a wait time (the 988 number connects to a network of more than 200 individual call centers around the U.S. and it can take a few minutes to find an available counselor) and how to sign off on a call or text chat. Earlier this year, the workgroup released a version for autistic youth and their caregivers.

Then last year, they achieved a goal long in the works: direct training for 988 counselors. Morgan and Maddox conducted three one-hour webinars for Vibrant that covered the fundamentals of autism, autism-specific suicide warning signs and support strategies for autistic people in crisis.

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The sessions were voluntary, and their recordings were placed in the online library of continuing education materials available to all 988 counselors. More than 1,200 people have already viewed the training live or watched the webinars, according to Vibrant.

No single approach works for every 988 caller, autistic or not. The goal is to expand the skills and ideas a counselor can draw from when trying to form a connection.

“Across multiple trainings, we have had attendees say or put in the chat, ‘These recommendations would be helpful for anyone,’” Maddox said. “If anyone is in crisis, do they want you spewing a lot of words at them [and] having this really long, wordy conversation? Or do they want you to be concise, to the point?”

Haight is now pursuing a doctorate in autism studies at Towson University in Maryland, and hosts meetings for autistic peer support groups. His long-term goal is to create a crisis hotline specifically for people on the spectrum, staffed by counselors who are either autistic themselves or have been trained by autistic people.

Right now, 988 offers callers direct access to counselors with specialized training in supporting veterans, another population with higher suicide rates than the national average. (A dedicated option for LGBTQ+ youth disappeared last year after the Trump administration terminated its funding.) Haight believes autistic people should have something similar.

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“I was convinced that a unique crisis support for autistic people must exist, given our high rate of suicidality and unique needs, so I searched for one, but I found none. What I did find was a wealth of evidence that a dedicated support should exist,” he said. “Autistic people have unique communication needs, yet crisis supports were not created with autistic needs in mind.”

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Amid E. coli outbreak, California-based Raw Farm voluntarily recalls cheddar cheese

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Amid E. coli outbreak, California-based Raw Farm voluntarily recalls cheddar cheese

Yes, Mark McAfee is pulling his cheese.

No, he is not happy about it.

The U.S. Food and Drug Administration asked McAfee’s Fresno-based Raw Farm weeks ago to voluntarily withdraw its unpasteurized cheese products from the market as the agency investigates an E. coli outbreak that has sickened nine people in three states — seven of them in California.

The U.S. Centers for Disease Control and Prevention has warned the public not to buy, sell or serve the company’s raw cheddar cheese, which five of those who had an E. coli infection say they ate before their illness.

For three weeks, McAfee refused to abide by the government’s wishes. But on Friday he finally relented, saying he has “involuntarily” recalled seven batches of cheese, even though the FDA has yet to confirm that E. coli has been found in any Raw Farm products. The agency has not issued a formal recall, though it has sent out a warning letter telling customers to avoid Raw Farm products purchased on or after Jan. 4, particularly raw milk cheddar cheese.

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“This Voluntary Recall is being performed under protest,” the company wrote in an announcement posted Friday by the FDA. “This Voluntary Recall is performed as a path forward.”

McAfee said he tests every batch of milk that comes out of his milking parlors, and none has been positive for E. coli, salmonella, campylobacter, listeria or any other contaminant that causes human illness. He has shared those results with both the FDA and state regulators, he said.

He said the agency came to his farm and “spent nearly a week” reviewing his tests.

“They were very impressed,” he said.

“There’s no pathogenic bacteria correlating us to anybody,” said McAfee. “What they did was a backdoor move. They said, ‘We’ll just let everybody know we’re concerned,’ and that is enough to have stores kick you out.”

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The FDA has not yet responded to requests for comment.

Last month, the FDA and CDC announced an investigation into an E. coli outbreak that since September has sickened nine people in California, Florida and Texas, three of whom have been hospitalized. More than half the cases are children aged 5 or younger. One patient required treatment for hemolytic uremic syndrome, a serious kidney complication.

Genome sequencing of E. coli isolated from each patient found that the strains were closely genetically related, suggesting that all of the ill people were exposed to the same source of infection.

State and local public health officials were able to interview eight patients or their caregivers. All said they’d consumed raw dairy products before falling ill. Two whose illness started in late 2025 said they drank Raw Farm’s raw milk, and five who fell sick in 2026 had eaten the company’s raw cheddar. (The eighth couldn’t recall the brand of the raw milk they drank.)

While testing of retail samples of Raw Farm cheese on sale in March found no E. coli, California has not ruled out the farm as the outbreak’s source given the number of patients who consumed its products before infection, a California Department of Public Health spokesperson said.

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“Retail cheese samples collected do not represent all raw cheese products sold by Raw Farm and may have been from different lots of production than those consumed by ill persons,” the agency said in a statement. “CDPH considers Raw Farm raw dairy the source of the outbreak based on this strong epidemiologic data, despite the negative laboratory testing results from a limited sample of retail products.”

Raw, or unpasteurized, dairy has not undergone the heating process that kills harmful bacteria while leaving nutrients largely intact. Raw Farm’s products alone have been associated with at least 239 reported cases of food poisoning since 2006, including a salmonella outbreak in October 2024 that sickened 171 people, according to Bill Marler, a food safety lawyer with Seattle-based MarlerClark.

He said the FDA’s decision to send out a warning letter instead of issuing a recall is “completely normal,” and the agency is very conservative when it comes to food safety.

“It makes sense, under the circumstances, to pull the product from the shelves,” he said of grocery stores. “Hell, if I was a retailer, I would pull it, because the last thing you’d want to do is have the product on the shelf, have it test positive for some E. coli, and have it poison some little kid and who then gets kidney failure.”

Proponents of raw dairy have long insisted that it prevents allergies and promotes beneficial bacteria, claims that are not supported by research. They include U.S. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime fan who celebrated the release of the 2025 “MAHA Report” with a shot of raw milk.

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McAfee was among those hopeful that Kennedy’s tenure would usher in a more favorable regulatory environment for raw dairy producers. But despite having been contacted by Kennedy surrogates before Trump’s second inauguration, he’s not heard from them since.

He said the administration has done little to promote raw dairy as part of a revamped food policy that emphasizes meat and whole-fat milk as essential for a healthy diet.

The FDA’s webpage about raw dairy was last updated during the Biden administration, and cautions people to avoid raw milk products and dispels research claiming it is healthy.

“They fired their best people at FDA and hired some good people and weird people and whatever,” McAfee said. “It’s so emblematic of a three-ring circus. The entire freaking administration is showing that through their lack of consistency, the lack of policy adherence, they just do what the hell they want to do.”

What has changed under the new administration is the FDA’s ability to carry out investigations like the one it says it has initiated at Raw Farm. Inspections, lab work and outbreak investigations are among the agency functions most hindered by significant staff reductions that have taken place since Trump took office, industry experts have warned.

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The Department of Health and Human Services has lost 18,200 employees since Trump took office, according to the Department of Personnel Management’s Federal Workforce Data tool. More than 3,000 of those losses were at the CDC, and about 4,500 were at the FDA.

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