It is not surprising that the U.S. has mad cow disease given our flaunting of World Health Organization recommendations.[1] What is surprising, however, is that we actually found a case given the inadequacy of our surveillance program, a level of testing that Nobel laureate Stanley Prusiner, probably the world’s leading expert on these diseases, calls simply “appalling.”[2] Europe and Japan follow World Health Organization guidelines[3] and test every downer cow for mad cow disease[4]; the U.S. has tested less than 2% of downers over the last decade.[5] Most of the U.S. downer cows, too sick or injured to even walk, end up on our dinner plates.[6]