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REAPPRAISAL OF THE CONTINUING PURSUIT OF A SOLUTION FOR VITAMIN A DEFICIECNCY DISEASE
- N Chandrasekharan (23 January 2001)
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Will children eat GM rice, or risk blindness from vitamin A deficiency?
- Indur M Goklany, Roger Bate, Kendra Okonski (9 February 2001)
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Genetically modified foods are not the only answer to address Vitamin A deficiency
- M G Venkatesh Mannar (17 February 2001)
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N Chandrasekharan, Nutrition Consultant Malaysian Palm Oil Board
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We have known vitamin A for over 80 years now and remarkable progress has been made in our knowledge of the causes and effects of its deficiency as well as in the various methods for its treatment and control. Nevertheless, the problem of vitamin A deficiency disease (VADD) continues to persist in many developing countries. It is reported that 251 million children are vitamin A deficient and of whom half a million will be irretrievably blinded and three million will die. This is despite the availability of foods rich in vitamin A and the existence of knowledge to deal with VADD. Vitamin A deficiency is the leading cause of childhood blindness and contributes to child mortality from infections. These are soul stirring statistics indeed. Where and why have we gone wrong are questions which not only continue to haunt us, but are also discussed and debated at many endless and regular conferences. There is also the realisation and admission of the failure or futility of the much advocated vitamin A capsule based programme. There is also widespread consensus that only a food based approach would probably be the most sustainable solution to effect permanent protection of at-risk populations from VADD1. A useful outcome has been the interest in the use of biotechnology for increasing food production as well as improving its nutritional value. The development and use of foods rich in provitamin A is receiving much attention and an area of focus is to increase ß carotene in foods. An added impetus has been the observation that the biological effects of the carotenoids extends beyond their provitamin A activity in preventive and protective health. Therefore it is no surprise that at a time, when there is an ongoing debate about the merits of genetically modified foods, the use of biotechnology is being exploited for producing provitamin A rich foods. A new variety of sweet potato (SPK 004) rich in ß carotene will act as a back up for UNICEF's vitamin A supplement programme. One hundred gramme of the sweet potato will provide a days requirement of ß carotene. It is planned to plant 5000 ha by 2004 at a cost of US3.2 million in South America. Meanwhile scientists in the Philippines are also working to wipe out VADD with genetically modified "golden rice" containing a yellow daffodil gene that is rich in ß carotene. Indian plant biologists are planning to acquire technology to create transgenic rice that will express ß carotene from local varieties of rice. It is reported that the Tata Energy Institute is acquiring from Monsanto transgenic technology to produce ß carotene in mustard oil- a popular cooking oil in India. A genetically modified tomato created at the University of London, contains 3.5 times more ß carotene than a normal tomato. Do these developments mean that a solution is in sight for VADD and thereby give room for imminent optimism? It is rather disturbing that in spite of the efforts made to reassure the public on the safety of genetically modified foods, there continues to be apprehensions, which need to be allayed. There is no denying that the stimulus for GMOs was to increase food production to meet the food needs of a growing population and nutritional enhancement of important food crops will be a major goal of biotechnology in the coming years. How soon can the fruits of science be savoured ? India's department of biotechnology said it could take up to seven years for the local varieties of transgenic rice and mustard oil to clear safety studies and obtain regulatory approval for commercial cultivation. For developing countries, the wisdom of spending scare resources on new and untested technologies is questionable, especially when there are other viable options available on hand for the VADD problem. It is in this context we have to reiterate the need to use existing resources optimally. A major human nutrient from time immemorial is oils and fats and palm oil is a major edible oil in the world today. Refined red palm oil is one of the richest natural source of carotenoids and is available in many countries where VADD is a problem. The efficacy of red palm oil in the reduction of VADD has been well established through both epidemiological and experimental studies 2. It is well acknowledged that populations who consume palm oil rarely develop VADD. Unfortunately, this knowledge as well as the full potential of red palm oil has not been fully exploited. Refined red palm oil needs to be used more effectively as it is a safe and effective vitamin A supplement offering a food based solution for VADD3. The continuing saga of the pursuit of a solution for VADD makes it apparent that VADD is not directly amenable to science and technology alone. It requires the application of economics and ethics and social conscience. Existing resources need to be fully used. It is therefore time for a reappraisal of the strategies for sustainable control of VADD. References: 1.Underwood BA. Dietary approaches to the control of vitamin A deficiency. Food and Nutrition Bulletin 2000;21:117-123. 2. Chandrasekharan N. Promoting vitamin A status. Lancet 1999;354:76 3 McLaren DS. Red palm oil. In Sight and Life Newsletter 2000; 3: 29- 30. N. Chandrasekharan,
Malaysian Palm Oil Board, Kuala Lumpur, Malaysia. |
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Indur M Goklany, Manager, Science and Engineering; Office of Policy Analysis US Department of the Interior, Roger Bate, Kendra Okonski
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Will children eat GM rice, or risk blindness from vitamin A deficiency? Dear Editor, We were struck by the photograph -- provocatively captioned, "Will these children be eating genetically modified rice in the future?" -- which accompanied Mr. Mudur's article on an Indian proposal to grow bioengineered crops to help reduce vitamin A deficiency. (1) However, it only raises half the issue. The other half of the issue is summed up by a parallel question: "Or will these children go blind from vitamin A deficiency?" We have taken the liberty of putting the two halves together, with accompanying photographs. ============================
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Photo: "A girl blind from corneal scarring, probably due to vitamin A deficiency precipitated by measles infection."
Courtesy: Sight and Life (Quarter 1, 1998), a newsletter of the Sight and Life Task Force (PO Box 2116, 4002 Basel,
Switzerland. Editor: Martin Frigg, http://www.sightandlife.org).
============================ By providing only half the picture (literally), the otherwise balanced news report risks creating for your readers the same trap as seems to have snared many advocates of a ban on GM crops. Such a ban has been justified on the basis of the precautionary principle, the environmentalists' version of the Hippocratic oath. But unfortunately while this justification takes credit for reducing risks that might result from a ban on GM crops (as hinted in photograph 1), it does not account for any risks generated (or prolonged) by the ban (depicted in photograph 2). Death and disease associated with vitamin A deficiency (VAD) are merely one class of malnutrition-related risks that such a ban might prolong. According to the World Health Organisation, each year vitamin A deficiency (VAD) is responsible for at least 350,000 pre-school children going totally or partially blind, about 60% of whom die within a few months of going blind (2). It also contributes to 1.1 million childhood deaths annually because of synergism between VAD and measles infection (2). Most formulations of the precautionary principle provide no guidance for evaluating a policy if it results simultaneously in uncertain benefits and uncertain harm. This contributes to one-sided accounting which, in turn, could result in a cure that is worse than the disease. In a recent policy study titled, "Applying the Precautionary Principle to Genetically Modified Crops", one of us has developed a framework to evaluate just such policies, where the net result might be ambiguous because their effects -- both beneficial and harmful -- are uncertain (3). This framework attempts to sort out competing claims on both sides of the ledger by considering, among other things, the nature, magnitude, and the certainty of the positive and negative effects of a ban, and the likelihood that a ban would reduce or aggravate those effects. Based on this, that study concludes that such a ban would more likely than not do more harm to public health (partly because it would make it harder to reduce vitamin A deficiency) as well as to the environment (because it would increase the amount of land and water devoted to agriculture, further intensifying the major threats to global biodiversity). Indur M. Goklany (4)
Roger Bate (Fellow) and Kendra Okonski (Research Assistant)
Notes 1. Mudur, G. India's plans to grow GM crops draw flak. BMJ 2001; 322: 126. (20 January.) 2. World Health Organisation. Vitamin A deficiency. Available at http://www.who.int/vaccines-diseases/diseases/vitamin_a.htm 3. Goklany, Indur M. Applying the precautionary principle to genetically modified crops. St. Louis, Missouri: Center for the Study of American Business, Washington University, 2000. Available from the Social Science Research Electronic Network at http://papers.ssrn.com/sol3/papers.cfm?cfid=76796&cftoken=89182273&abstract_id=246530 4. Views expressed here are the author's and not necessarily those of the Department of the Interior or any other unit of the U.S. government. |
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M G Venkatesh Mannar, Executive Director, The Micronutrient Initiative Ottawa, Canada
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The need to ensure that all children receive adequate quantities of Vitamin A is undisputed. The impacts of clinical and sub-clinical Vitamin A deficiency on the well-being and survival of millions of children is undisputed. Mr. Mudur's article and the accompanying photograph seem to convey the impression that the only solution to the problem is to promote the consumption of genetically modified foods. No mention is made of the fact that over the past five years signficant inroads have been made in addressing the problem through known and cost-effective methods. Over 60% of the world's children (under the age of 5 years) are now protected by biannual doses of high dose Vitamin A capsules provided by Canada through the Micronutrient Initative and distributed in over 60 countries by UNICEF. The fortification of staple foods (such as cooking oils, sugar and cereal flours) with Vitamin A is progressively gaining ground in many parts of the world. In fact by the time the technology for genetically modified foods rich in Vitamin A is accepted and ready for widespread application, we expect that a major proportion of the world's affected children will already be protected through a combination of supplements and fortified foods. The new goal proposed for the UN General Assembly is to eliminate the problem by the year 2010. A balanced approach to GM foods for any type of application including nutritional enhancement of foods is to first demonstrate their safety and then prove that they can be applied more widely and cost-effectively than the approaches that we are already applying today. |
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