Dear all:

I want to make a clear statement on the fact that I consider certain ideas ignorant and 
not necessarily people.  I have held many ideas which I have realized with more insight 
were misguided or even ignorant.  With deeper reflection, those ideas have been revised 
or abandoned.

The specific "idea" that I find ignorant is that a single intervention can conquer all the 
health problems in developing area of the world.  In this regard, I do find that the Bill 
Gates foundation follows that pattern of looking at one "magic bullet" intervention in 
isolation, rather than the combination of interventions that would improve the health 
situation.  Just as you cannot simply implement a water and sanitation intervention and 
eliminate all disease transmission because malaria is transmitted via blood and insect, 
HIV via body fluids including blood, and measles is transmitted via droplet spread --- you 
cannot conquer all the world's health problems with a multivitamin supplement either. So, 
the substitution of ONE "magic bullet" intervention for another "SINGLE" long-term 
intervention that does not address a huge chunk of transmissions routes is the idea that I 
find ignorant.  

Nevertheless, while you are building a gardening program in an area that has so much 
drought and environmental degradation that even the goats are vitamin A deficient, you 
can enable many more children to survive until that gardening program, along with 
programs to assist women to develop acceptable, palatable recipes for those new foods, 
and to ensure that the kids, not the men are eating some of those foods.  Even though I 
am definitely on the side of food being the answer and have never taken a nutritional 
supplement myself, not even as a child --- there are circumstances I've seen specific 
supplements stave off death long enough to arrive at a longer term solution.  If there are 
simply no green plants available to eat, you will not find a source of beta-carotene to 
convert to retinol.  Furthermore, human milk remains a good source of retinol and beta-
carotene even in deficient conditions and can mitigate the effects of deficiency during the 
first six months of exclusive breastfeeding.  

Like the New York Times Sunday magazine article that exposed the problems caused by 
the "Nutrification of Foods" that has led some in search of the "magic nutrient' that will 
cause them to live forever or be slim or beautiful or the "bad food" that if were 
eliminated from the diet would produce the same result ---- it is clear that you must look 
at the bigger picture of interactions. The effects of single nutrients cannot be really 
evaluated in isolation from food and meals and even the overall health of the person 
eating those foods.  The "magic bullet" bullet approach to evaluating interventions in 
developing areas of the world have resulted in a competitive process for funding rather 
than a process of looking far more carefully about which interventions truly complement 
each other and result in synergistic improvements in health.  What is not as commonly 
known even in nutrition circles is that there is a branch of epidemiology that goes well 
beyond a linear approach and this branch validates much of what careful observers can 
often detect before the number crunchers --- and that is looking at effect modification. 
Personally, I think the qualitative observational approach discovers these relationships far 
faster than the quantitative approach. 

I also have problems with the "dumping" of "surplus" foods during famine situations 
because these do not resolve the long term problems.  Yet, in the face of many who are 
dying, I would not deny food to those who need it. I would work harder to put into place 
those programs that would prevent the famines from ocurring and more locally available 
resources for emergency conditions that cannot always be anticipated.

Some topics such as immunizations and abortion are topics about which some of us have 
such deeply held convictions based on our personal experiences and beliefs that we may 
never agree.

What we CAN agree about is that breastfeeding is a central intervention to a huge array 
of unnecessary health problems in developed and developing countries alike.  It is a sad 
state of affairs that breastfeeding has BECOME an intervention and not the norm.  When 
we have less than two of five infants younger than six months who are exclusively 
breastfed --- and slightly more than one out of five infants younger than six months who 
are exclusively breastfed in the areas of the world with the highest infant mortality rates 
--- and the lack of breastfeeding increases many infectious and chronic diseases --- and 
the lack of breastfeeding contributes to environmental degradation in many ways --- and 
the lack of breastfeeding contributes to psychological detachment as well --- we really 
have a global crisis that deserves constant attention.  

Best, Susan Burger

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