Thursday, December 30, 2010

Orange Things

I just have to say this: I love Nicholas D. Kristoff. I really do. His efforts to raise awareness of crimes against women and girls worldwide have been heroic. And his overall work to shine a light on areas of inequity and poverty are enough to qualify him for, if not a full saint, then at least someone working his way up the rungs of the sainthood ladder. But his Thanksgiving day column that encouraged the development and use of biofortification of certain crops in developing nations gave me pause.

At first glance, one might wonder what's wrong with breeding crops to incorporate iron, zinc, Vitamin A or other important vitamins and minerals into their edible parts. After all, these substances can save vision and lives. As he noted,
"It may turn out that one of the best ways to save children's lives, or to save women in childbirth, doesn't involved doctors, but rather, high-tech seeds." 

Sounds simple, cheap, and easy, right? At the risk of being all wet-blanket-y about it, I think it sounds neither simple nor cheap and also as if it has great potential for unintended consequences.

There are two avenues of research here - conventionally bred crops produced in the public domain, and genetically modified ones developed and owned by corporations. Developing nutrient-dense crops available to anyone is a noble idea and enabling families in Africa to grow vitamin-packed orange sweet potatoes instead of the typical white sweet potatoes that they always have grown is a great idea. However, once it gets more complicated than that scenario, I have concerns.

For one thing, I have long been uncomfortable in rushing science in the name of helping impoverished countries. After all, the United States and Europe are still grappling with the role genetically-modified crops - of which many biofortified crops would be - can play in feeding their citizens, especially in light of the facts that pests are growing resistant to some of those expensive, herbicide-intensive crops and the long-term implications of ingesting those crops are not fully understood even by those who embrace them.  It also seems like bringing back the buggy whip when you consider that some of the crops that are proposed will require pesticides and herbicides, chemicals whose use citizens in the developed world are trying to minimize, due to the mounting evidence of their health and environmental hazards. So why do we think making ever-more complicated plants and encouraging their use in impoverished areas are good ideas - especially when individuals in developed countries are clamoring for simpler, organic, back-to-basics clean food? Is cast-off technology from the developed world the best we can offer to developing countries?

Some may argue that that imperfect solutions are better than nothing when the stakes are as black and white as survival versus death . There is a grain of truth to that argument, which basically falls under the heading of "don't just sit there, do something." However, we already have a perfect solution - vitamins exist in pill and powder forms and some designer waters are already enhanced with some of those vitamins. The problem is that vitamins are too expensive for many developing countries, and the logistics of getting them to every person on a regular basis can be daunting. However.

For-profit companies do just that.

Let's repeat that sentence.

For-profit companies do just that.

They just don't do it with vitamins.

But they do it with cigarettes. And they do it with soft drinks. It no longer surprises me when I see the cheery red and white of Coca-Cola products in the Amazon basin in Brazil or a kid puffing on a Marlboro in Thailand. It seems when the bottom line is at stake, human ingenuity finds ways to source components of products, assemble those products, and then figure out how to market, deliver, and sell them regardless of the challenges presented by the location. For example, by harnessing local ingenuity and providing a profit incentive, Coca Cola has mastered the logistics of getting its, shall I say,  product-of-questionable-nutritive-value into the most remote reaches of Africa. And I believe one of Coke's products is vitamin-enhanced water.

Therefore, for this particular problem, it may be better to practice what Buddhists know: "Don't just do something, sit there." Just sit there and think. Look around. Take a page from Melinda Gates' play book and learn what we can from what Coca-Cola already does.

One of the reasons I would encourage the public health world to look for a simpler solution is firsthand knowledge of how long it can take to create these complicated plants and then figuring out how much of them individuals would have to ingest in order to attain certain levels of the vitamin. Years ago, I used to manage a series of seminars for the American Cancer Society. These seminars were very high-level. The audiences were top-line national medical and scientific reporters. The presenters were the researchers who push the envelope, like the ones who brought you Gleevac, virtual colonoscopies, and basic knowledge about cancer including oncogenes and suppressor genes. The panel chairpersons were directors of national cancer centers, Nobel laureates, and Mary Lasker Award winners. The seminars were three days of intense science and emerging research.

One presentation in 1996 showcased a scientist from Roswell Park Cancer Institute who presented her research on "Transgenic Plants as a New Vaccine Source." The specific project she was working on was inserting hepatitis B antigens into bananas. Once eaten, the theory was that the antigens would effectively vaccinate the banana eaters against hepatitis B,  a leading cause of liver cancer around the world. This edible vaccine would be especially useful, the scientist postulated, in developing countries, where cost and logistics create obstacles to vaccinating the local population.

Sound familiar?

Fourteen years after that presentation, there is still no banana/hepatitis B vaccine. A quick Google search of "hepatitis vaccine banana" returned 27,000 hits, showing that research is still going strong on this concept. But still no edible vaccine.

I'm sure you can see where I'm going with this. We already have vitamins and vaccines against many diseases. What is being proposed - biofortification of existing plants to enable them to carry vitamins - is expensive research. Then, intensive education programs must be carried out so that individuals in countries that need these plants can learn how to grow, harvest, and cook them. And no one has done the research - asked the individuals who will be expected to grow these plants - if they are interested in changing their social norms to eat orange sweet potatoes instead of the white ones, or golden rice instead of white rice. And, last I checked, these plants are still in development.

So, with all due respect to the researchers and to Mr. Kristoff, I'd rather put my money on creating partnerships between the public health world and Coca-Cola or other global brands to oversee the distribution of vitamins that we already have, instead of investing a lot of money into a more complicated situation. The price seems to be a red herring at some level - after all, individuals seem to have the money to purchase Coke products, as evidenced by Mexico's astonishing 665 per capita ingestion of Coke products in 2009. Or, if you want to go further with this concept, Coca-Cola already makes VitaminWater. Couldn't the public health world work with Coke to develop a VitaminWater to deliver the key vitamins lacking in certain parts of the world?

We already have vitamins. Multi-national corporations have distribution systems and perhaps even products that can be tweaked to provide specific nutrients to children, or pregnant women, or the elderly. What seems simple to me is not the creation of complicated seeds that require costly chemicals and unpredictable weather to grow, but a linkage that would combine the best of the knowledge from the public health world and the infrastructures of big corporations in order to get those vitamins where they can do a lot of good.

PS to Mr. Kristoff. I still think you rock.