<p>What is Plumpy’nut? Sound it out, and you get the idea: it’s an edible paste made of peanuts, packed with calories and vitamins, that is specially formulated to renourish starving children. Since its widespread introduction five years ago, it has been credited with significantly lowering mortality rates during famines in Africa. Children on a Plumpy’nut regimen add pounds rapidly, often going from a near-death state to relative health in a month. In the world of humanitarian aid, where progress is usually measured in subtle increments of misery, the new product offers a rare satisfaction: swift, visible, fantastic efficacy.<br /><br />Plumpy’nut is also a brand name, however, the registered trademark of Nutriset, a private French company that first manufactured and marketed the paste. It was not the intention of Plumpy’nut’s inventor, a crusading pediatrician named André Briend, to create an industry around Plumpy’nut. Briend, his friends say, was always personally indifferent to money. (Also, apparently, to publicity — he declined repeated requests to be interviewed for this article.)<br /><br />One element of genius in Briend’s recipe was precisely its easy replicability: it could be made by poor people, for poor people, to the benefit of patients and farmers alike. Most of the world’s peanuts are grown in developing countries, where allergies to them are relatively uncommon, and the rest of the concoction is simple to prepare. On a visit to Malawi, Briend whipped up a batch in a blender to prove that Plumpy’nut could be made just about anywhere.<br /><br />Others, however, quickly realised that the miracle product had more than just moral value. Nutriset has aggressively protected its intellectual property, and the bulk of Plumpy’nut production continues to take place at Nutriset facilities in France. (Unicef, the world’s primary buyer, purchases 90 per cent of its supply from that factory, according to a 2009 report prepared for the agency.)<br /><br />Internationally, there has been a vituperative debate over who should control the means of production, with India going so far as to impose sharp restrictions on Plumpy’nut, calling it an unproven colonialist import. Elsewhere, local producers are simply ignoring the patent. In Haiti, two manufacturers are making products similar to Plumpy’nut independently of Nutriset: one is Partners in Health, the charity co-founded by the prominent global-health activist Paul Farmer.<br /><br />A beginning<br />Partners in Health harvests peanuts from a 30-acre farm or buys them from a cooperative of 200 smallholders. It’s planning to build a larger factory, but for now the nuts are taken to the main hospital in Cange, where women sort them in straw baskets, roast them over an outside gas burner, run them through a hand grinder and mix all the ingredients into a paste that is poured into reusable plastic canisters.<br /><br />Patents are meant to offer incentives to innovators by giving them a time-limited right to exclusively exploit their ideas for profit. But many say that lifesaving products should be treated by a different set of rules. There has been a long and bitter argument, for instance, over the affordability of patented AIDS drugs in Africa. Critics have made a similar case against Plumpy’nut, which is fairly expensive, costing about $60 per child for a full two-month treatment. “We were concerned because of the way Nutriset was managing their intellectual property,” said Stéphane Doyon, a nutrition specialist with Doctors Without Borders, a medical charity. “We felt that there was the possibility for the creation of a monopoly.”<br /><br />“Poverty is a business,” Patricia Wolff, a St Louis pediatrician, said. She founded Meds and Food for Kids, the other local producer of fortified nut paste in Haiti. When I first spoke with her in May, Meds and Food for Kids was struggling to raise money to expand its operations, and Patricia complained mightily about the difficulties she faced because of Nutriset’s market dominance.<br /><br />When it came time to eat their own meal, a three-course luncheon, the party guests found seats at tables set with elaborate centerpieces, made up of stuffed bears and Plumpy’nut packets. As volunteers sold raffle tickets for a Dior handbag, Navyn Salem delivered a practiced speech. Earnest and attractive, with wide brown eyes, she told the audience that her father, a member of an Indian merchant family, grew up in Tanzania. <br />“There are over a billion people in our world that are malnourished,” Navyn said. “It’s a shocking statistic. The good news is there’s a very simple solution.” And that, she said, was Plumpy’nut. “It’s really revolutionary, because it doesn’t need to be mixed with water or refrigerated,” Navyn continued. “And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.”<br /><br />This transformation, seen in before-and-after photos — on one side a sick and wasted child, on the other, a chubby, smiling one — was the promise that captured imaginations far beyond the technocratic community of specialists that originally developed Plumpy’nut. “People love a silver bullet,” says prominent nutritionist Steve Collins. Navyn’s decision to devote a portion of her family’s fortune to the cause was impressive, but she is hardly the only person who was touched by the substance’s potential.<br /><br />At the benefit, many of the attendees said they had seen the same inspiring ‘60 Minutes’ segment, in which Anderson Cooper compared the paste to penicillin, concluding that it “may just be the most important advance ever” in the realm of childhood malnutrition. After Navyn spoke, she began squeezing dabs of Plumpy’nut onto plates and passing them around, assuring the partygoers that the brownish goo was surprisingly tasty, with the consistency and sweetness of a cookie filling. Everyone ate it right up. <br /><br />Plumpy’nut proved so palatable and so valuable that it was only natural that other interests were now trying to take a bite. “You want to hear about the bad stuff?” Navyn whispered. There was a lot to talk about. Outside the restaurant, beyond the protective cordon of appreciation, rival factions were fighting over a less innocent — though perhaps no less important — issue: who should profit? Plaintiffs were suing, accusing her partners at Nutriset of anticompetitive practices to protect their position atop a $200 million marketplace. Doctors, foreign-aid organisations and agribusinesses were staking competing claims, each invoking the interests of the world’s most fragile children. “Forget all the politics,” Navyn pleads. “I’d like to erase them all.” But try as she might, she can’t wish away the questions of property and law.<br /><br />Everyone, it seemed, wanted to own a bit of Plumpy’nut.<br /><br />At the beginning, the problem was devilishly simple: malnutrition was killing millions in poor countries — it’s thought to be responsible for a third of all deaths of children under 5. And yet the global medical community was expending little effort to develop improved treatments. In the early 1990s, the accepted regimen for severe acute malnutrition — a watery mixture fed through a tube — was 30 years old and was unable to prevent the deaths of 20 to 60 per cent of patients in hospitals. Frustrated, a small group of doctors began searching for a better way to get nutrients into starving children. One of them was André Briend.<br /><br />According to legend, Briend hit upon the inspiration for Plumpy’nut one morning at the breakfast table, when, after years of vainly mixing nutrients into cookies, pancakes and yogurt, he opened a jar of Nutella, and the idea came to him: a paste! Like most such stories, this one is not completely true — or rather, it elides many years of false starts, research, scientific collaboration and infighting.<br /><br />Right ingridient<br />The first advance came in the form of F100, a dried high-energy milk that was fortified with a mix of vitamins and minerals that were designed to counter the specific biochemical effects of malnutrition in children. F100 had to be mixed with water, though, which in poor countries was apt to be rife with bacteria. It also tasted unpleasant. As a childhood-nutrition expert attached to a French government institute, Briend came up with the idea of mixing F100 together with peanuts, milk, sugar and oil. The concoction was full of protein and fat, which insulated its nutrients from oxygen and humidity and masked their unappetising flavour.<br /><br />The true advance lay not in the formulation, however, but in the way the paste could be put to work. Earlier treatments had to be administered in a hospital setting, which meant a long, expensive stay away from home for both mother and patient, so children were rarely brought in for treatment until they were already extremely weak and susceptible to all the pathogens that lurk in third-world health facilities.<br /><br />What Briend and a few other specialists envisioned was a treatment that could be administered at home, by families instead of doctors. For medical professionals, this required a radical shift in mind-set. Briend searched the world for someone willing to conduct field tests, cautioning that collaborators in his experiments, as he put it in a 2000 message to a malnutrition Listserv, “should be ready to accept a road with trial and errors.”<br /><br />One doctor who decided to take a risk was Mark Manary, a pediatrician and professor, who was working at a hospital in Malawi. His malnutrition ward was crammed full of dozens of children lying on mats. “It was really an incredible burden,” Manary recalled. <br />“These kids are deathly ill, you’re doing whatever you can for them, and you think you’re on the right track, and then you come in the next morning and four of them have died.”<br />Manary emptied out the ward, sending his patients home with Plumpy’nut. Many malnutrition experts were horrified. “It seemed dangerous to them, and it made them afraid,” said Manary, who recalled that one eminent figure stood up at a conference and said, “You’re killing children.” In fact, when the results were analysed, it was found that 95 per cent of the subjects who received Plumpy’nut at home made a full recovery, a rate far better than that achieved with inpatient treatment.<br /><br />Economic demand<br />Briend’s invention may satisfy a need, the hunger of children, but that doesn’t directly correspond to economic demand, which is set by buyers — the donor nations and international agencies that spend billions of dollars on food aid and famine relief. This is the gap Navyn Salem is hoping to fill. Her mission is twofold. First, her plant manufactures Plumpy’nut for sale. Second, she is trying to use publicity and humanitarian appeals to persuade the customer base — the foreign-aid donors — to allocate more money to purchase and distribute the product. <br /><br />She didn’t know much about famine relief or the insular community of nutritionists who deal with it, but she had a professional background in advertising and marketing, and she wanted to do something that drew on what she saw as her natural entrepreneurial strengths. “I thought, Let’s figure out if we can run a business that saves thousands and thousands of lives,” she said. In her factory, Navyn led me to a gleaming stainless-steel tank, which was about as tall as she was and hot to the touch. She opened a door on top, and a fragrant peanut smell wafted out as we craned to look in. “Here it is,” Navyn said. “The magic stuff.”<br /><br />Scientists have shown that there is, in the words of ‘The Lancet’, ‘a golden interval’ for childhood nutrition that occurs before the age of 2. “This is the period when brain growth is very extensive and babies are developing their immune systems,” said Kathryn Dewey, a professor in the department of nutrition at the University of California, Davis. Stunting that persists after age 2 is generally irreversible, while improved nutrition in early childhood correlates to greater educational success.<br /><br />One study, in Guatemala, showed that boys given a nutritional supplement as babies made 46 per cent higher wages as men. Dewey has been testing whether Nutributter, one of Nutriset’s new (and patent-protected) products, might achieve similar results. “There has to be a way to break the cycle of poverty and malnutrition that has plagued these populations for hundreds and hundreds of years,” she said. “That’s the more grandiose vision of where this is headed.”<br /></p>
<p>What is Plumpy’nut? Sound it out, and you get the idea: it’s an edible paste made of peanuts, packed with calories and vitamins, that is specially formulated to renourish starving children. Since its widespread introduction five years ago, it has been credited with significantly lowering mortality rates during famines in Africa. Children on a Plumpy’nut regimen add pounds rapidly, often going from a near-death state to relative health in a month. In the world of humanitarian aid, where progress is usually measured in subtle increments of misery, the new product offers a rare satisfaction: swift, visible, fantastic efficacy.<br /><br />Plumpy’nut is also a brand name, however, the registered trademark of Nutriset, a private French company that first manufactured and marketed the paste. It was not the intention of Plumpy’nut’s inventor, a crusading pediatrician named André Briend, to create an industry around Plumpy’nut. Briend, his friends say, was always personally indifferent to money. (Also, apparently, to publicity — he declined repeated requests to be interviewed for this article.)<br /><br />One element of genius in Briend’s recipe was precisely its easy replicability: it could be made by poor people, for poor people, to the benefit of patients and farmers alike. Most of the world’s peanuts are grown in developing countries, where allergies to them are relatively uncommon, and the rest of the concoction is simple to prepare. On a visit to Malawi, Briend whipped up a batch in a blender to prove that Plumpy’nut could be made just about anywhere.<br /><br />Others, however, quickly realised that the miracle product had more than just moral value. Nutriset has aggressively protected its intellectual property, and the bulk of Plumpy’nut production continues to take place at Nutriset facilities in France. (Unicef, the world’s primary buyer, purchases 90 per cent of its supply from that factory, according to a 2009 report prepared for the agency.)<br /><br />Internationally, there has been a vituperative debate over who should control the means of production, with India going so far as to impose sharp restrictions on Plumpy’nut, calling it an unproven colonialist import. Elsewhere, local producers are simply ignoring the patent. In Haiti, two manufacturers are making products similar to Plumpy’nut independently of Nutriset: one is Partners in Health, the charity co-founded by the prominent global-health activist Paul Farmer.<br /><br />A beginning<br />Partners in Health harvests peanuts from a 30-acre farm or buys them from a cooperative of 200 smallholders. It’s planning to build a larger factory, but for now the nuts are taken to the main hospital in Cange, where women sort them in straw baskets, roast them over an outside gas burner, run them through a hand grinder and mix all the ingredients into a paste that is poured into reusable plastic canisters.<br /><br />Patents are meant to offer incentives to innovators by giving them a time-limited right to exclusively exploit their ideas for profit. But many say that lifesaving products should be treated by a different set of rules. There has been a long and bitter argument, for instance, over the affordability of patented AIDS drugs in Africa. Critics have made a similar case against Plumpy’nut, which is fairly expensive, costing about $60 per child for a full two-month treatment. “We were concerned because of the way Nutriset was managing their intellectual property,” said Stéphane Doyon, a nutrition specialist with Doctors Without Borders, a medical charity. “We felt that there was the possibility for the creation of a monopoly.”<br /><br />“Poverty is a business,” Patricia Wolff, a St Louis pediatrician, said. She founded Meds and Food for Kids, the other local producer of fortified nut paste in Haiti. When I first spoke with her in May, Meds and Food for Kids was struggling to raise money to expand its operations, and Patricia complained mightily about the difficulties she faced because of Nutriset’s market dominance.<br /><br />When it came time to eat their own meal, a three-course luncheon, the party guests found seats at tables set with elaborate centerpieces, made up of stuffed bears and Plumpy’nut packets. As volunteers sold raffle tickets for a Dior handbag, Navyn Salem delivered a practiced speech. Earnest and attractive, with wide brown eyes, she told the audience that her father, a member of an Indian merchant family, grew up in Tanzania. <br />“There are over a billion people in our world that are malnourished,” Navyn said. “It’s a shocking statistic. The good news is there’s a very simple solution.” And that, she said, was Plumpy’nut. “It’s really revolutionary, because it doesn’t need to be mixed with water or refrigerated,” Navyn continued. “And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.”<br /><br />This transformation, seen in before-and-after photos — on one side a sick and wasted child, on the other, a chubby, smiling one — was the promise that captured imaginations far beyond the technocratic community of specialists that originally developed Plumpy’nut. “People love a silver bullet,” says prominent nutritionist Steve Collins. Navyn’s decision to devote a portion of her family’s fortune to the cause was impressive, but she is hardly the only person who was touched by the substance’s potential.<br /><br />At the benefit, many of the attendees said they had seen the same inspiring ‘60 Minutes’ segment, in which Anderson Cooper compared the paste to penicillin, concluding that it “may just be the most important advance ever” in the realm of childhood malnutrition. After Navyn spoke, she began squeezing dabs of Plumpy’nut onto plates and passing them around, assuring the partygoers that the brownish goo was surprisingly tasty, with the consistency and sweetness of a cookie filling. Everyone ate it right up. <br /><br />Plumpy’nut proved so palatable and so valuable that it was only natural that other interests were now trying to take a bite. “You want to hear about the bad stuff?” Navyn whispered. There was a lot to talk about. Outside the restaurant, beyond the protective cordon of appreciation, rival factions were fighting over a less innocent — though perhaps no less important — issue: who should profit? Plaintiffs were suing, accusing her partners at Nutriset of anticompetitive practices to protect their position atop a $200 million marketplace. Doctors, foreign-aid organisations and agribusinesses were staking competing claims, each invoking the interests of the world’s most fragile children. “Forget all the politics,” Navyn pleads. “I’d like to erase them all.” But try as she might, she can’t wish away the questions of property and law.<br /><br />Everyone, it seemed, wanted to own a bit of Plumpy’nut.<br /><br />At the beginning, the problem was devilishly simple: malnutrition was killing millions in poor countries — it’s thought to be responsible for a third of all deaths of children under 5. And yet the global medical community was expending little effort to develop improved treatments. In the early 1990s, the accepted regimen for severe acute malnutrition — a watery mixture fed through a tube — was 30 years old and was unable to prevent the deaths of 20 to 60 per cent of patients in hospitals. Frustrated, a small group of doctors began searching for a better way to get nutrients into starving children. One of them was André Briend.<br /><br />According to legend, Briend hit upon the inspiration for Plumpy’nut one morning at the breakfast table, when, after years of vainly mixing nutrients into cookies, pancakes and yogurt, he opened a jar of Nutella, and the idea came to him: a paste! Like most such stories, this one is not completely true — or rather, it elides many years of false starts, research, scientific collaboration and infighting.<br /><br />Right ingridient<br />The first advance came in the form of F100, a dried high-energy milk that was fortified with a mix of vitamins and minerals that were designed to counter the specific biochemical effects of malnutrition in children. F100 had to be mixed with water, though, which in poor countries was apt to be rife with bacteria. It also tasted unpleasant. As a childhood-nutrition expert attached to a French government institute, Briend came up with the idea of mixing F100 together with peanuts, milk, sugar and oil. The concoction was full of protein and fat, which insulated its nutrients from oxygen and humidity and masked their unappetising flavour.<br /><br />The true advance lay not in the formulation, however, but in the way the paste could be put to work. Earlier treatments had to be administered in a hospital setting, which meant a long, expensive stay away from home for both mother and patient, so children were rarely brought in for treatment until they were already extremely weak and susceptible to all the pathogens that lurk in third-world health facilities.<br /><br />What Briend and a few other specialists envisioned was a treatment that could be administered at home, by families instead of doctors. For medical professionals, this required a radical shift in mind-set. Briend searched the world for someone willing to conduct field tests, cautioning that collaborators in his experiments, as he put it in a 2000 message to a malnutrition Listserv, “should be ready to accept a road with trial and errors.”<br /><br />One doctor who decided to take a risk was Mark Manary, a pediatrician and professor, who was working at a hospital in Malawi. His malnutrition ward was crammed full of dozens of children lying on mats. “It was really an incredible burden,” Manary recalled. <br />“These kids are deathly ill, you’re doing whatever you can for them, and you think you’re on the right track, and then you come in the next morning and four of them have died.”<br />Manary emptied out the ward, sending his patients home with Plumpy’nut. Many malnutrition experts were horrified. “It seemed dangerous to them, and it made them afraid,” said Manary, who recalled that one eminent figure stood up at a conference and said, “You’re killing children.” In fact, when the results were analysed, it was found that 95 per cent of the subjects who received Plumpy’nut at home made a full recovery, a rate far better than that achieved with inpatient treatment.<br /><br />Economic demand<br />Briend’s invention may satisfy a need, the hunger of children, but that doesn’t directly correspond to economic demand, which is set by buyers — the donor nations and international agencies that spend billions of dollars on food aid and famine relief. This is the gap Navyn Salem is hoping to fill. Her mission is twofold. First, her plant manufactures Plumpy’nut for sale. Second, she is trying to use publicity and humanitarian appeals to persuade the customer base — the foreign-aid donors — to allocate more money to purchase and distribute the product. <br /><br />She didn’t know much about famine relief or the insular community of nutritionists who deal with it, but she had a professional background in advertising and marketing, and she wanted to do something that drew on what she saw as her natural entrepreneurial strengths. “I thought, Let’s figure out if we can run a business that saves thousands and thousands of lives,” she said. In her factory, Navyn led me to a gleaming stainless-steel tank, which was about as tall as she was and hot to the touch. She opened a door on top, and a fragrant peanut smell wafted out as we craned to look in. “Here it is,” Navyn said. “The magic stuff.”<br /><br />Scientists have shown that there is, in the words of ‘The Lancet’, ‘a golden interval’ for childhood nutrition that occurs before the age of 2. “This is the period when brain growth is very extensive and babies are developing their immune systems,” said Kathryn Dewey, a professor in the department of nutrition at the University of California, Davis. Stunting that persists after age 2 is generally irreversible, while improved nutrition in early childhood correlates to greater educational success.<br /><br />One study, in Guatemala, showed that boys given a nutritional supplement as babies made 46 per cent higher wages as men. Dewey has been testing whether Nutributter, one of Nutriset’s new (and patent-protected) products, might achieve similar results. “There has to be a way to break the cycle of poverty and malnutrition that has plagued these populations for hundreds and hundreds of years,” she said. “That’s the more grandiose vision of where this is headed.”<br /></p>
