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Rice, Rice, baby
Rice, Rice, baby

Alright stop, collaborate and listen
Rice is back with my brand new invention
Vitamin A grabs me tightly
Letting me see daily and nightly
“Will it ever stop?” Yo, I don’t know
Turn off the lights, and I’ll see the glow
To the extreme, genes in rice like a vandal
Light up a cones and rods like a candle
Cornea clear, no necrosis, boom
Not killing your eyes like a poisonous mushroom
Deadly, with no vegetable melody
Children going blind should be a felony
Love it or leave it, you better gangway
You better hit bullseye, the kid don’t play
If there was a problem, yo, I’ll solve it
Check out the rice while my gene revolves it

Rice Rice Baby

Vanilla Ice. That brings back memories.

A couple of years ago, pre-COVID, I was enjoying a beautiful summer day on the front
porch. Probably writing one of these beloved and insightful essays.

A pair of young women walked up the path to the porch. Female and no matching white shirts. Not Mormon, likely Jehovah’s’ Witnesses. They seem to come around every year or two. I grimaced internally and prepared to blow them off.

Nope. They were Greenpeace acolytes, looking for money to fight climate change.

I was a sucker for climate change pleas, back before I concluded that it was all futile. But before I gave them any money, I asked if Greenpeace had made any amends for their irrational opposition to golden rice and all the harm it had caused. I was uncertain at the time as it had been a while since I had seen anything on the topic

They hadn’t heard of golden rice. Well, I said, look it up and get back to me if they have done their penance.

They never returned.

When I was starting out in medicine, oh so many years ago, insulin was isolated from the pancreases of slaughterhouse cows and pigs. The problem was that these insulins are immunologically different than human insulin and a fair number of patients would develop antibodies against their insulin, making the diabetes harder and harder to control. It often did not end well.

And then.

Someone figured out how to put human insulin genes into E coli and suddenly we had insulin that was not immunogenic. Well, not so suddenly. It was expensive and, then as now, diabetics were often priced out of life-saving insulin.

As an aside, what kind of society allows life-saving insulin to be cost prohibitive?

Anyway. The principle, if not the execution, is simple. Cells are little machines that turn DNA into RNA and RNA can then produce pretty much any biologic product you need or want. Like insulin. The Wikipedia has a list of biologic products available as a result of this recombinant technology. Including golden rice.

What, you may ask, is golden rice and who cares?

Humans are unable to synthesize a number of micronutrients aka vitamins. Vitamins are curious. They are critical for some physiologic processes but many species never acquired, or lost, the ability to make their own vitamins. Like vitamin C:

Vitamin C (ascorbic acid) plays important roles as an anti-oxidant and in collagen synthesis. These important roles, and the relatively large amounts of vitamin C required daily, likely explain why most vertebrate species are able to synthesize this compound. Surprisingly, many species, such as teleost fishes, anthropoid primates, guinea pigs, as well as some bat and Passeriformes bird species, have lost the capacity to synthesize it.

Which I find fascinating, that once we could make vitamin C, but no longer.

Humans cannot synthesize vitamins A, B1 (thiamine), B2 (riboflavin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), B12 cobalamin), E and K but are able to synthesize some vitamin B3 (niacin) and D.

Let’s talk about vitamin A. It has two main forms in food. Retinol in meat and carotenoids in vegetables. Humans need to eat one or the other to stay replete in their vitamin A.

Much of the world does not have access to the jaw-dropping selection of foods found in the local Safeway needed to avoid vitamin deficiency As such, vitamin A deficiency is common in SE Asia and sub-Saharan Africa, affecting children and pregnant females.

About 250,000 to 500,000 malnourished children in the developing world go blind each year from a deficiency of vitamin A, around half of whom die within a year of becoming blind.

That is awful. No one with a shred of conscience would support policies that result in thousands of children going blind and dying? Right?

The simplest intervention would be to give children at risk just 2 doses a year of vitamin A. That decreases blindness and all-cause mortality by 12 to 24%. Easy peasy. Would that the world worked so smoothly — only 59 percent of targeted children were reached in 2022, with East Asia and the Pacific achieving the lowest coverage at 20 percent, followed by Eastern and Southern Africa at 57 percent.

More ways to get vitamin A into people are needed. Human ingenuity being what it is, very clever people discovered how to put the genes beta-carotene, a vitamin A precursor, into rice. Viola. Golden rice, a potential partial solution to vitamin A deficiency, especially where rice is a diet staple.

Golden Rice looked good to go in the Philippines until April of this year when the Court of Appeals in the Philippines issued a cease-and-desist order on the commercial propagation of two genetically modified crops, golden rice and Bt eggplant, citing a lack of “full scientific certainty” regarding their health and environmental impact.

And who filed a petition to halt the Golden Rice? Greenpeace.

Greenpeace! Heros from my youth. Eco-warriors who put their lives on the line, steering their Zodiac boats into the paths of whaling ships to save the whales. An organization with cred. Lots of cred. Unfortunately, since misleading claims from credible sources can be more damaging than blatant falsehoods.

Greenpeace has a long history of opposing GMOs and has been fighting the introduction of golden rice, and other GM foods. Actions do have consequences, and the consequences of opposing golden rice is that more Filipinos are going to go blind and die, given that around 17% of children in the country are vitamin A deficient and they rely on rice as their main source of nutrition. Greenpeace says in response to the ruling

“Significantly, the decision firmly upholds the Precautionary Principle and puts the burden of proof for safety on the respondents. Greenpeace has constantly noted that GM crops have been approved in the Philippines despite the lack of robust data on safety assessments submitted by proponents. GM crops have never been proven safe, and have hindered necessary progress on climate resilient ecological agriculture that keeps the control of seeds on our farmers.

“We reiterate our stance: the involved companies and agencies have yet to show concrete evidence that these crops would be in the best interest of Filipinos, our environment, and our agricultural sector.

Greenpeace does not address the blindness and death that will occur as a result of this decision. As best I can tell, there is but one mention of blindness and death in all the Greenpeace golden rice blog posts, preferring to focus on other issues. Wonder why that is. However, as is so often the case for the poor and powerless, those who make the rules do not play the game.

The Precautionary Principle, huh?

From basic biology, I can’t see why Golden Rice would present a problem. We eat the genes and their products that make Vitamin A every day to our benefit. As one review noted

There are no cases where post-market surveillance has uncovered harm to consumers or the environment including potential transfer of DNA from the GMO to non-target organisms.

I suspect Greenpeace doesn’t realize when we say that someone is now, tragically, in a vegetative state, we are speaking metaphorically. Vegetable genes have not jumped into the patient.

I can’t find where there have been any worrisome effects from transgenic foods, specifically golden rice. As another review noted

Transgenic crops are subjected to a rigorous pre-market safety assessment. The safety of novel proteins and other products is established, and through compositional analysis and animal studies, the safety of any observed changes is evaluated. These studies provide evidence that the new product is as safe as, or safer than, comparable varieties. It must be asked, however, if this rigorous analysis is necessary, because unregulated crops produced by other breeding methods also undergo genetic changes and contain unintended effects. Golden Rice poses infinitesimally small, if any, risk to consumers whilst it has the potential to spare millions of lives each year. However, because it is a transgenic crop, it cannot be deployed without years of expensive pre-market safety review. Paradoxically, if Golden Rice had been produced by less precise conventional methods of breeding, it would already be in the hands of poor farmers.

Try as you might, you can’t cross-breed a carrot with rice. A shame, really. Although I look forward to eating a tomato-fish. Hope they use San Marzanos.

As far as I can tell, there is no a priori reason golden rice would be dangerous and there is no data to suggest it is a danger.

It looks like the US has approved at least 10 GMO crops while places like the the Philippines get nothing.

When it comes to GMO food crops, anti-GMO campaigners have thus won a remarkable yet dubious victory. They have not prevented rich countries from using GMO animal feed or GMO cotton, yet farmers and consumers in poor countries need increased productivity for food crops, not animal feed or industrial crops. Today’s de facto global ban on GMO food crops therefore looks suspiciously like an outcome designed by the rich and for the rich, with little regard for the interests of the poor.

Same as it ever was.

If you like the Nobel Prize gambit, and I am not so sure I do, but a decade ago 107 Nobel laureates signed a letter calling for Greenpeace to stop it, noting

Scientific and regulatory agencies around the world have repeatedly and consistently found crops and foods improved through biotechnology to be as safe as, if not safer than those derived from any other method of production. There has never been a single confirmed case of a negative health outcome for humans or animals from their consumption. Their environmental impacts have been shown repeatedly to be less damaging to the environment, and a boon to global biodiversity

Greenpeace didn’t stop it.

Greenpeace’s anti-GMO stance has been called a crime against humanity, and their actions do fit the definition, although history and current events suggest it is rare that anyone really cares about crimes against humanity. Kind of sucks that Greenpeace prefers to support laws that result in people going blind and dying despite all the negative studies.

In medicine, there are never any good solutions to medical problems. There are bad solutions and worse solutions. Interventions are about risks and benefits, trying to determine the least bad solution.

The risks of vitamin A deficiency are well known and common. The benefits of vitamin A are well established. The risks of golden rice appear to be as close to zero as one would like. Seems a simple and safe enough partial solution to a very real problem. If I were given a choice, I would prefer the benefit of my children being able to see and to live to the ripe old age of 71 rather than dying young and blind weighed against the vanishingly small chance of a risk from golden rice.

But the courts of the Philippines ruled otherwise. Hm. Justice is blind, perhaps from vitamin A deficiency. A shame she did not have golden rice as a child so she could read the literature and see the mistake being made.

The nice thing about working in health care is I could look in the mirror at the end of the day and know that my actions improved someone’s life, at least a little. I always wonder how those whose actions lead to suffering and death look at themselves in the mirror at the end of the day and know they have made the world a little, or a lot, worse. They probably do not consider it; no one is evil in their own story. Much the pity. It would be so much simpler if people and organizations acted like Snidely Whiplash, twirling the ends of their moustashe as they tied golden rice to the train tracks. But we lack a Dudley Do-Right in this metaphor. I guess ole Nell is doomed.

As another aside, as best I can determine, whales have a diet high in vitamin A and are themselves an excellent source of the vitamin for Eskimos. Imagine what would have happened if whales needed golden rice to survive or the only solution to vitamin A deficiency in humans had been to eat the whales. Golden rice seems so much more civilized.

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  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.

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Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.