Silent but not Deadly

By Thomas R DeGregori

Silent but deadly is a phrase most often used to describe the effects of a quiet crepitation that is extremely potent in its olfactory impact. It could as well refer to the phobias of many concerning the deadly forces of modern life. These are the forces of modern life that allegedly pervade our environment and threaten our very existence. Vying for the top of the list are those all-pervasive chemical carcinogens that allegedly saturate our food and every other aspect of our environment. Competing for phobic primacy is all that deadly radiation emanating from nuclear power plants. When old phobias begin to lose some of their power to frighten, there are people skilled at heightening our sensitivities to newly emerging dangers such as transgenic or genetically modified food or food irradiation. Like the old soldiers who never die, some old phobias seem to linger on: the dangers of immunization or the connection between electric power lines and cancer (a fore runner to the mobile phone-brain cancer phobia), or even the harm from pasteurization. Unlike the old soldiers, however, old phobias never quite seem to fade away.

Being unseen and silent makes the threats of modern life ever more frightening. Our unawareness of these dangers means that we need sentinels who shoulder the responsibility for constantly alerting us to them while seeking our contribution to their organizations. Little evidence is ever required for the validity of this danger, and as belief builds upon belief, each new danger seems to validate beliefs about the older ones, with an emerging consensus among the nervous that modern life is dangerous. Dangers that one can see or hear can eventually be verified or falsified - and so can the unseen dangers, but this is a matter of scientific evidence, a notion which is not universally accepted.

Modern life has protected us from so many of the dangers that were once a frequent scourge to the very young and the old and many between, that the very safety of modern life has relieved us of the fear of them. This seems to have opened a niche to be filled in with new fears. The very success of modern life in allowing us to live longer, healthier lives should, in aggregate at least, stand as a massive refutation of those whose livelihood is fear -mongering. Like the "curious incident" of the dog that didn't bark in Conan Doyle's Silver Blaze, the story of our time might be told in terms of cancer epidemics or other disasters that many people believe happened but didn't.

I often ask my students to guess how many of them would be here if the birth and death rates of 1900 had prevailed throughout the century. Based on the study of Kevin M. White and Samuel H. Preston (1996), if 1900 birth and death rates had prevailed throughout the century, half of them would not be here. This half extends across all age groups. For the older among us, we might well have been born but would have likely already died. For my students, half of them would also not be here, having died at birth or in childhood, or never having been born because a parent or grandparent did not live long enough to have children. It is easy to cite the various infirmities that took their toll before the arrival of modern public health and/or pharmaceuticals. For citizens from the developing world, without the changes in mortality in just the last half century, one quarter of them would not be alive had 1950 death rates prevailed (Heuveline 1999). Statistically, this is even a more extraordinary feat than the one-half for the century. How many of them realize that they or a pre-reproductive parent would have been the Grim Reaper's prize, without the last century's scientific and technological changes that have transformed modern life? A few might have been the beneficiaries of some heroic life-saving procedure, but the vast majority of those of us now alive simply do not know whether or not we would be among the living or the dead without the life-saving capabilities of modern life.

Most of us are the beneficiaries of the silent but life-saving forces that have emerged over the last century. Factors such as clean water and immunization are taken for granted - except when scares arise about their alleged dangers. Our children can be immunized with up to eleven injections at an age that they can no longer remember when they become adults. Even I as a beneficiary of the 20th century have to marvel at the fact that these eleven immunizations contain fewer antigens than the one smallpox vaccination that I had as a boy. Yet the fears about immunization grow louder and more strident as the immunizations become ever safer.

We benefit from the advances of our time, memories of which often lie in the hidden recesses of our minds - until we are called upon as parents to have our own children protected by immunization or cured with an anti-biotic. Equal in importance to the benefits of what is there, are the benefits from what is no longer in our operating environment or which is at least reduced to levels more manageable by our immune system. It is the unseen micro-organisms that are no longer in our food or water (at least not in the concentrations that can be life threatening) that allow us to safely partake of the food and drink that quite literally sustain our life; or it is the carcinogenic smoke that no longer fills the indoor atmosphere of our homes as a result of not cooking and heating with open wood fires. In other words, our lives are sustained by all the things that are unseen because they are no longer there, or those life-saving items like immunization and antibiotics that are not always visible. For antibiotics or immunization, it is not only the protection that we receive when we contact the disease but also the protection we receive from not getting ill because others are also protected.

A recent article and editorial in the American Journal of Clinical Nutrition illustrated a silent but life-saving factor of modern life (Pfeiffer et al. 2005 and Rosenberg 2005). It concerned the results of the 1998 mandating of folic acid fortification. "Mandatory folic acid fortification of cereal grain products was introduced in the United States in 1998 to decrease the risk that women will have children with neural tube defects" (Pfeiffer et al. 2005). The study demonstrated that "every segment of the US population appears to benefit from folic acid fortification" (Pfeiffer et al. 2005). The earlier scientific study "of folic acid fortification as an approach to prevent neural tube defects is a latter day example of the application of meticulously controlled scientific trials to insightful previous hypotheses and observational studies. These controlled trials led the FDA to mandate folic acid fortification of the diet" (Rosenberg 2005).

The decision for the folate mandate was taken in a very open democratic way with opportunity for informed support or criticism. It would not have been difficult for some activist group to campaign against it on the ground that we were surreptitiously experimenting with pregnant mothers, infants and children without fully understanding the unknown dangers lurking menacingly in the background. With the folate mandate, there was no thought of consumer choice. No doubt groups skilled in public advocacy would have found it easier to frighten people than scientists would have found it to inform them. Fortunately, no major group opposed it. Few outside those professionally interested (and informed) knew about it. One can guess - and it is only a guess on my part - that those most in need of the folate supplementation are likely to be the poor and least educated, who would also most likely (another guess) be least aware of the mandate or that folate had been added to their bread.

Vitamins were first identified in 1914, and the first vitamins were commercially available in the 1920s. "The synthesis of folic acid by Lederle Labs in 1947 was one of the milestones achieved during the era of discovery of vitamins in the first half of the 20th century. This stable and unreduced form of folate has served wonderfully in preventing and treating folate deficiency and for much of the study of folate biology" (Rosenberg 2005). It should be noted, for those who are willing to pay a premium for a vitamin if it is labeled "all natural" that "folic acid is not the natural form of the vitamin as it exists in food" (Rosenberg 2005). In a sense, most vitamins in pill form are unnatural (to the extent that that means anything), as we get most of our vitamin intake as part of complex proteins. "Although folic acid is not the natural food form of this vitamin (6), folic acid fortification has resulted in a profound improvement in nutritional status and has had a substantial effect on the original target - neural tube defects" (Rosenberg 2005). It should also be noted that excessive intake can be harmful, which should be of interest to those who pop mega-doses of vitamins and other substances in the belief that they are somehow following Nature's path to a longer life.

The efficacy of "folic acid supplementation during the periconceptional period for the prevention of spina bifida and related neural tube defects" has been demonstrated, as has "food fortification as the most feasible approach to increasing folic acid intakes in women before conception" (Rosenberg 2005). There are other studies which find that increased folate intake during the periconceptional period leads to a reduction in childhood leukemia, and others again which indicate that increased folate intake may help in delaying the onset of Parkinson's disease. How many of the beneficiaries of this intervention even know that they are beneficiaries, and how many of the rest of us even know that a "silent" life-saving product has been added to our bread? How many parents of a healthy baby know that the nutritional status of the mother would have resulted in a newborn with spina bifida and related neural tube defects if it had not been for the mandated folate fortification?

Following the publication of the study showing the benefits of the 1998 folate enrichment mandate, another peer-reviewed report was announced, which argued that even more lives would be saved from deadly disease with a larger dose of folate in flour. Even our most beneficial interventions can be subject to further debate, though in this case, the dispute concerns the possibility of even greater benefit, not whether there is benefit. This does reflect the difference between science and non-science. No human action of any kind is ever totally free of risks. In some instances perceived risks are very real, but dwarfed by the magnitude of the benefits. The realized risks become a new problem to solve by means other than foregoing the massive benefit. In the case of folate, there is the risk that folate intake can mask a severe vitamin B-12 deficiency until irreparable nerve damage results from it. In cognizance of that, vitamin B-12 deficiency was examined in the study and others are arguing for vitamin B-12 enrichment along with the folate.

Even with a great success story, some scientists will undoubtedly find ways that it might be made even better. Other scientists who accept the benefits of folate enrichment might disagree that more is needed, or even that more would be beneficial. In modern interventions in science and technology, there is always room for improvement and even more room for disagreement. What is too often not recognized is that those in the most heated disagreement may in fact be in agreement (along with others in their profession) about basic principles, and be arguing about their interpretation or about peripheral issues which may have important applied implications.

Unfortunately the professional anti-science practitioners will seize on these disagreements, magnify them, and use them to argue against established scientific theories and often against scientific inquiry itself. Given that PhD scientists number into the hundreds of thousands, activists will have no difficulty rounding up a few who support their anti-science agenda. Science is a form of open inquiry in which every belief can be subject to challenge by those who might have a better theory, and evidence in support of it, that is better than what is currently believed. This is one of the ways in which progress is maintained. But some theories are so solidly established in terms of the supporting evidence and the effective use to which they are being put, that criticism of them carries a significant burden of necessary evidence. By creating a public belief that there is a "controversy" in an area of scientific inquiry and that scientists are "divided" on the issue, activists use "mythic" controversy to further an agenda such as opposition to beneficial endeavors such as genetically modified (technically, transgenic) agriculture and food production, immunization of various kinds, and the teaching of evolution. Let's face it, though they may be poles apart politically and hold each other in utmost contempt, there are striking similarities between those who oppose modern biotechnology or modern science and technology in general, and those whose advocacy of creationism/intelligent design pits them against modern biology. Some of us might argue that though the superficial rhetoric may be different, the underlying belief systems of the two groups are virtually identical.

By vociferously and convincingly denying the benefits of a practice, critics claim no obligation to offer an alternative except to abandon the practice. Or they endless repeat clichés such as "we have enough food in the world to feed everyone" without having to answer how could we have gotten enough food in the world to feed everyone without the Green Revolution technologies that they also opposed, and how will we feed another possibly 3 billion people by 2050 without new yield improving technologies?

Given the extraordinary gains that we have made over the last century in life expectancy, it would seem obvious that we must be doing something right. In the 20th century, in the United States we added nearly 30 years of life expectancy and reduced infant mortality by over 90%. Other advanced countries did even better, in some cases much better that we did. In developing countries, about 20 years of life expectancy have been added in the last 50 years. Changes of these magnitudes do not happen for no reason at all. To repeat, we must be doing something right. We therefore have a right to ask critics if they are opposing the very processes that brought us these gains? If there is a problem such as an adverse reaction to an immunization that is otherwise beneficial, are they advocating that we seek a solution to the problem or that we simply forego the process entirely, benefit and all? Do they have an alternative that produces more benefit with less risk, and what is their evidence for it? In other words, we have as much right to demand answers from the critics as the critics have to demand answers from the rest of us. Too many critics seem to be operating under the assumption that we were better off in some prior time.

No matter how far we advance, there will always be errors and potential harm, and there will always be a vital need to have those who seek out problems and to publicize and seek to remedy them. It is critics of this kind that have been an essential element in getting us where we are today. There is much more than a semantic difference between those whose criticism springs from a basic acceptance of the gains that we have made, and the criticism that seeks to recapture that which we have lost or that finds ideological solace and vindication in every failure in science, technology and modern life. The latter will opportunistically seek fault where ever they can find it, whether it be real or imaginary. To some of us, their seeming joy in every failure is mean spirited and anti-human. For critics to escape this Luddite trap, their critique of any aspect of modern life has to be cognizant of the silent but powerful forces moving in the background that have so dramatically transformed our lives for the better.

Dr. Thomas R. DeGregori is a Professor of Economics, University of Houston. He is widely published - his most recent books include: Origins of the Organic Agriculture Debate; The Environment, Our Natural Resources, and Modern Technology and Agriculture and Modern Technology: A Defense (Blackwell Publisher for all three) and Bountiful Harvest: Technology, Food Safety, And The Environment (Cato Institute). Author's homepage is http:www.uh.edu/~trdegreg and email address is trdegreg@uh.edu.

References

ASSOCIATED PRESS. 2005. 'Vitamin B Pills May Not Stop Heart Attacks', The New York Times, 6 September.

Brent, Robert L. and Godfrey P. Oakley, Jr. 2005. 'The Food and Drug Administration Must Require the Addition of More Folic Acid in "Enriched" Flour and Other Grains', Pediatrics 116(3):753 755, September.

Heuveline, Patrick. 1999. 'The Global and Regional Impact of Mortality and Fertility Transitions, 1950-2000'. Population and Development Review 25(4):681-702, December.

Mestel, Rosie. 2005. Study Says Folic Acid Additive Cut Defects', Los Angeles Times, 6 September.

Pfeiffer, Christine M; Samuel P Caudill; Elaine W Gunter; John Osterloh and Eric J Sampson. 2005. 'Biochemical indicators of B vitamin status in the US population after folic acid fortification: Results from the National Health and Nutrition Examination Survey 1999-2000', American Journal of Clinical Nutrition 82(2):442 450, August.

REUTERS. 2005. 'Adding Folic Acid to Grain Reduces Birth Defects, Study Finds', The New York Times, 6 September.

Rosenberg, Irwin H. 2005. Editorial: 'Science based micronutrient fortification: which nutrients, how much, and how to know?', American Journal of Clinical Nutrition 82(2):279 280, August.

Tanne, Janice Hopkins. 2005. 'US study shows that folic acid fortification decreases neural tube defects', BMJ 331(7517):594, 17 September.

White, Kevin M. and Samuel H. Preston. 1996. 'How Many Americans Are Alive Because of Twentieth-century Improvements in Mortality?' Population and Development Review 22(3):415-429, September.

Williams, Laura J.; Sonja A. Rasmussen; Alina Flores; Russell S. Kirby, and Larry D. Edmonds. 2005. Decline in the Prevalence of Spina Bifida and Anencephaly by Race/Ethnicity: 1995-2002.

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