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The Lancet and the Royal Society are both right and wrong

Crawford M and colleagues (2005) The Lancet  366 714-715 

Web URL: View this article on the Lancet website here

Abstract:

The exchange between The Lancet and the Royal Society(1,2) is important because it brings to focus the failure of health policy to prevent the escalation of obesity, heart disease, diabetes, and western cancers. A primary reason has been the skew in perceived scientific priorities which sidelined nutritional science in relation to health. This skew deprived the UK government of comprehensive advice, with consequences that have escalated globally. I will mention three notable examples.

First, in the 1970s, the Neuberger Report on Nutrition Research to the Medical Research Council recommended that research should be done on the cause and prevention of low birthweight and its associated consequences. The House of Commons Select Committee on Children 1989, and in 1991, on Maternity Services, made the same recommendation. The failure of biomedical science and health services to respond was articulated when, in view of the attached high risk of neurodevelopmental impairment and chronic ill health, a parliamentary question by Lord Morris of Manchester in June, 2004, asked the government about its progress in reducing low birthweight. He received the written reply that the incidence was 6·6% 1953, 6·6% in 1973, and 7·6% in 2002. The UNICEF 2005 Report(3) puts the UK at 8%, worse than Cuba and on a par with Romania and Kazakhstan.

Second, when the price of soya rocketed, the UK government was advised that it was fine to feed animals with protein derived from animal offal etc, instead of food from plants. Their advice ignored nutritional evidence of Clausen and Moller(4) in Denmark, who showed in 1967 that injection of foreign brain protein into the footpad of rats could cross the blood-brain barrier and cause a destructive autoimmune response if the rats were depleted of the essential fats required for the integrity and function of neural cells. The nutritional requirement for the brains of cattle was ignored, resulting in the epidemic of bovine spongiform encephalopathy seen in the 1990s.

Third, changes in dietary lipid profiles across the population have been linked to increased vascular diseases. Because vascular development in the embryo and placenta is a prerequisite for fetal brain growth, of which lipid nutrition is also a dominant feature, the prevalence of mental ill health was predicted in 1972 to increase in a similar way.(5) At the Letten Symposium of the McCarrison Society at the Royal Society in May, 2004, an audit of the cost of the burden of ill health in the UK by Mike Rayner of the British Heart Foundation placed mental ill health second after heart disease.

Robert May and David Read(2) state that policymakers receive advice on medical science from a cluster of elite organisations. Much good advice has been given. However, the examples above and many others show that there is a major gap in this system. Either the gap stems from sheer ignorance of the science or there has been a wilful bias against preventive medicine in favour of curative medicine. The rise in obesity, diabetes, and mental ill health, and the spread of previously unknown western diseases across developing countries illustrates the failure of the advisory system to which May and Read refer.

At the same time, The Lancet's idea for an Institute of Medicine(1) is too narrow to deal with the challenge posed by this multidimensional threat. We have to attend to the start of life - ie, the nutrition and health of the mother, which is a high form of preventive medicine and insurance for a better future in health and prosperity. If we fail to respond to the challenge, the untellable cost will be to the health and abilities of future children worldwide.

Signatories of this letter are:

  • Kebreab Ghebremeskel (Institute of Brain Chemistry and Human Nutrition, London, UK);
  • Joseph R Hibbeln (National Institutes of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA);
  • Simon House (The McCarrison Society, Southsea, UK);
  • David Hunter (UK Health Association);
  • David C Morley (University of London, UK);
  • Paul Nicholson (Zacchaeus 2000 Trust, London, UK);
  • Kenneth Stuart (Mother and Child Foundation, Sandy Lane, Barbados).


References

1. The Lancet. What is the Royal Society for?. Lancet 2005; 365: 1746. Full Text | PDF (38 KB) | CrossRef
2. May R, Read D. What is the Royal Society for?. Lancet 2005; 365: 2173. Full Text | PDF (43 KB)
3. UNICEF. The state of the world's children 2005. New York: UNICEF, 2004:.
4. Clausen J, Moller J. Experimental allergic encephalomyelitis provoked in rats after developmental lack of polyunsaturated fatty acids. Acta Neurol Scand 1967; 43 (suppl 31): 74.
5. Crawford MA, Crawford SM. What we eat today. London: Neville Spearman, 1972:.

Affiliation

Mother and Child Foundation, 36 Regent's Park Road, London NW1 7SX, UK

Copyright © 2005 The Lancet, Elsevier Limited. All rights reserved.