Those of you who are old-timers, or else browsing in some library and looking at what we have learned to term a ‘hard copy’ of this journal, will see that this column is now within the sports pages at the back of the book. We have considered a change of title, to ‘Parthian Shot’ or ‘Sting in the Tail’. But we are a cuddly columnist, and with the support and blessing of the editorial board will stay with Out of the Box.

Eagle eyes will also spot an adjustment of sub-titles below: these now include keywords, designed to be SESE (specialist expert and search engine) friendly, and thus to bump up our impact factor. Referencing style now is also designed to make each item self-contained. As always, if you are provoked by anything in this column, especially if you think it is wrong or you have an alternative point of view, the letters pages are open to you.

World politics

Money makes the world go phut

What do we do, as professionals and as citizens, now that the bubble has burst and we all see that unregulated capitalism leads to calamity? (Note italics.) How does this bear on the work of public health nutritionists?

We have of course been here already, before our own lifetimes. John Maynard Keynes, of whom we hear more these days, wrote The Economic Consequences of the Peace ⁽Reference Keynes¹⁾ in a state of sustained disgust and rage. He had participated as a member of the British delegation in the Versailles conference, convened to make peace after the First World War, whose real resolve was to ruin Germany. Versailles created chaos and sowed the dragon’s teeth from which Nazism and Adolf Hitler then sprang⁽Reference MacMillan²⁾.

The book begins with a passage recollecting the charm of pre-war days. For the superior classes ‘life offered, at a low cost and with the least trouble, conveniences, comforts, and amenities beyond the compass of the richest and most powerful monarchs of other ages’. He pictures somebody like himself, who ‘could order by telephone, sipping his morning tea in bed, the various products of the whole earth, in such quantity as he might see fit, and reasonably expect their delivery upon his doorstep’. He could ‘adventure his wealth in the natural resources and new enterprises of any quarter of the world, and share, without exertion or even trouble, in their prospective fruits and advantages’. Above all ‘he regarded this state of affairs as normal, certain, and permanent, except in the direction of further improvement, and any deviation from it as aberrant, scandalous, and avoidable’.

Then between 1914 and 1991 came the Great War, and then the Russian Revolution, the Great Crash, the Second World War, the A-Bomb, the H-Bomb and the Cold War, in the period sometimes known as ‘the short century’⁽Reference Hobsbawm³⁾.

So what now?

The next period, between 1991 and 2008, will be seen as somewhat similar to the two decades or so between 1890 and 1914. Privileged people – probably such as you – in materially rich countries have been in another dream world, beyond the compass of all but a few of the rich and powerful of a century ago. Similarly, most of us, no doubt with occasional queasy feelings, have imagined that economic growth was fixed. Now we know otherwise, and will always remember this, leaving future generations to remain ignorant until their time comes. So what do we do now?

My first observation is that the current financial tumult, which surely presages a world slump, means that we all are a little less emotionally distant from most people in the world, who live in a permanent state of insecurity, and of whom a substantial proportion – maybe a billion, maybe more – live in misery. We also may sip tea, but our mornings are no longer serene. My second observation is that the world’s impoverished majority, who watch the world on television in halls and bars if not personally at home, get the drift of world affairs as much as we do, with the advantage over us of not being in a state of frenzy or panic about shares and savings, and now see us differently. Now they know for sure that we do not have the answers.

Read and consider the commentary by Claudio Schuftan in this issue, written from Saigon, in which he reflects on the responsibilities of public health nutritionists in our inequitable and insecure world, drawing from a deep well of knowledge, wisdom and sympathy⁽Reference Schuftan⁴⁾. His bottom line is that equitable sustained improvements in health and nutrition spring not from the experts, but from the communities themselves, who can then be encouraged and empowered in partnerships with professionals who accept that people who live in poverty basically know best what they need. See what you think – and feel.

US politics. UN politics

US elections, UN s/elections

The prevailing ideology of any US administration affects us all in our work. Any sense of jubilation at the astounding election of Barack Obama as US President, sensing him to be a combination of Martin Luther King and John F. Kennedy, should be tempered. Why? Well first, in Britain in May 1997 so many people felt that with the election that made Tony Blair UK Prime Minister, a sleazy and failed regime had been replaced by a new generation of bright shining idealists. Then… well, we know – some of it, anyway. Politics is a rough old trade. Second, it is not so long ago that JFK and then Martin were assassinated. Don’t assume that an Obama administration is going to be in a hurry to get out of Iraq, and don’t imagine that the Iraqi oilfields will ever be re-nationalised or that Iraqi crude will be traded for petroeuros⁽Reference Perkins^1–Reference Klein³⁾.

Looking on a brighter side, the family backgrounds of Barack Obama and of Joe Biden make them real people. Promising aspects of President-Elect Obama include his personal knowledge of and family connection with Africa, his experience of living in Indonesia and Hawai’i in not specially privileged circumstances, and his training in the rough and tumble of Chicago politics. In a completed first term, his best moves may be not what he does but what he does not do.

Hope for the UN system?

Also – and now I come to the point directly relevant to our work – I guess that he will stand somewhat aloof from the Bush II regime imperialists, and may well allow the UN system to recover some of its representative responsibilities on behalf of we used to call ‘the family of nations’. Whether he will back any such wise policy with adequate funding that does not bind UN agencies to the bidding of the US State Department, remains to be seen.

This brings me to the UN System Standing Committee on Nutrition (UN SCN), a cryptic body that now just might be able to work well.

As you probably know, the purpose of the SCN is to co-ordinate the policies and programmes of what are now the nineteen UN agencies whose work concerns or impinges on food and nutrition – a good idea, since some of them tend to fight like cats in a sack. In the 1990s, with the cautious and collegiate Richard Jolly as chair, the SCN developed into a tripartite group in which the UN agencies and representatives of official national bilateral agencies were joined by a growing number of people from civil society organisations. Nobody imagined that the SCN was about to save the world, but it did good work.

In the 2000s, two US citizens with a background in Republican politics, Catherine Bertini and then Ann Veneman, were appointed as successive SCN chairs, presumably in the expectation or hope that the SCN would fall into line with the general move towards the privatisation of public health. The circumstances of their appointments remain mysterious, but we can be sure that the UN officials who rationalised their accession believed that the US President’s office would be pleased. Early in 2005 this journal undertook to report on the progress of Ann Veneman, whose previous appointment was as US Agriculture Secretary in the Bush II administration⁽Reference Margetts⁴⁾. She can be judged as a disaster or a triumph, depending on where you are coming from. On the one hand, according to my informants in the system, she was peremptory and dismissive. There again, by the time when last October she let it be known that she would not seek another three-year term, the SCN was – and is – eviscerated and discredited, as witness a scorching review in The Lancet ⁽Reference Morris, Cogill and Uauy⁵⁾.

As this column goes to press, four candidates for the next SCN chair have been identified, and one may be anointed before you read this. Two are the subtle David Nabarro, an Englishman with long senior service in WHO; and the redoubtable Urban Jonsson, a Swede with a unique history within UNICEF. I know the other two names, but the notes circulated on the process of election (or is it selection?) do not make clear whether or not they know they are candidates, and nobody will tell me. This is a UN custom, not likely to generate zeal.

My advice to the indefatigable Roger Shrimpton, who as SCN general secretary after six years doing his best with Carherine Bertini and Ann Veneman will retire this year, is to abandon the s/election, wait to test the mettle of the new US administration, and then encourage identification of other charismatic candidates, create an open competition, and select a new chair whose first job will be to raise money from or through sources whose business and interests are independent from those of the UN. No, not Nestlé or Yum! Foods, nor Sir Bob or Sir Bill. Nor, I suppose in these difficult times, Russian oligarchs or investment bankers. But then… maybe the canny vote for the next SCN chair goes to the candidate whose mobile has already stored the private line of George Soros.

Peanut allergy. Food allergies. Premature weaning

The causes of food allergy

Here, according to the ingredients list on its label, is an item I encountered in-flight on a United Airlines trip from Washington, and consumed in the interests of research. As you may know, in these days of the decline and fall of the business classes, some carriers offer passengers in steerage not meals but adult versions of kiddie-gunk, wrapped in plastic, which you may eye and then open and after a while devour with a plastic fork-cum-spoon, which in this case I dutifully did.

The label says: ‘Hand made with whole grain oats, brown sugar, margarine (liquid soybean oil, palm oil, water, salt, mono- and diglycerides, soybean lecithin, natural flavor, annatto color, vitamin A palmitate), sugar, unbleached wheat flour, raisins (may contain sulphur dioxide as a preservative), whole eggs, water, natural and artificial vanilla flavor, cinnamon, salt, baking soda, made with love!’ (What does hand made with love mean? Rolled in the palms of dusky maidens?) Then: ‘Contains wheat, soy, egg, manufactured on equipment that processes peanuts, almonds, hazelnuts, pecans, walnuts and milk ingredients’.

A couple of weeks later I can still smell the aroma on the packing of this ‘Oatmeal Chewie’ (with 0 g trans fat). The most interesting bit on its label is after the ‘made with love!’ schmoozery. This is a litany of warnings enjoined by lawyers, that let the manufacturer off the hook should a passenger – or any other consumer – suffer anaphylactic shock, spastic colon or the runs, as a result of exposure to wheat, milk, eggs, soya, peanuts (or indeed other nuts – news to me). The warnings are still of the ‘by the way, here is something for you to read after you have solved the puzzles in the in-flight magazine’ variety, and nothing like those now telling you that smoking cigarettes makes your legs rot, kills your babies and shrivels your lungs to the consistency of coprolites. But after a few-score cases of passengers going into shock and their loved ones sueing the socks off airline companies and food manufacturers, who knows?

All too much

Scary stuff! This led to a discussion with a colleague whose young grand-daughter suffers after eating even a trace of peanuts, and who has collected a pile of academic papers on the topic. Leafing through, I find that they collectively indicate that peanut allergy is multifaceted and cross-disciplinary. Naturally; this turns the wheels of research. Keep it complicated!

Here by contrast is a common-sense explanation. The bodies of young children are liable to react against any food when they are fed it too young and too often. The basic cause of lactose intolerance is immature immune systems rejecting cow’s milk. Coeliac disease is caused by an overwhelming amount of kiddi-glop being based on wheat – and only a few strains, at that. The average daily food supply for adults in the USA contains 768 kcal from wheat, plus 257 kcal from soya beans, and another 554 kcal from maize (corn)⁽Reference Pollan¹⁾. Milky and eggy products are touted as staples for tots. This is all too much.

And peanuts? The Oatmeal Chewie label gives the game away. Peanuts are everywhere in processed products. As soon as little bodies identify a food as poison they may become, in the trade phrase, ‘exquisitely sensitive’ to it – even to trace scourings from multi-tasked machines.

There is another reason. Antibiotics may penetrate the mucosal lining of the gut and some strip it off in patches, exposing the inner gut wall. With its outer defences down, the body’s immune signals go haywire and identify many foods as poisons⁽Reference Cannon²⁾. Do busy physicians prescribe antibiotics to harassed mothers whose young children are suffering from self-limiting infections? They sure do.

Plus another thought. Is it the food that triggers the allergic reaction, or is it what is done to the food? One of the pile of peanut papers suggested that a factor is the intensity of the roasting process. Likewise, is fresh raw whole cow’s milk as allergenic as dried pasteurised skimmed cow’s milk? Also, what about contaminants not mentioned on food labels, such as bovine hormones and drugs in milk, aflatoxins in peanuts, and biocides in practically everything? But now I am getting into detail. I offer the broad brush theory of food allergy, which is: first, premature weaning; second, dependence on only a few foods that are also staple ingredients; and third, the exacerbation of antibiotics. Keep it simple!