Nevin S.

Scrimshaw (1918-2013): Remembrances Alok Bhargava (University of Maryland School of Public Policy, College Park, MD 20742; The death of Nevin Scrimshaw on 8 February 2013 at the age of 95 has left the nutrition and social science communities in grief. It is perhaps fair to say that along with Ancel Keys and John Waterlow, Nevin was among the most influential nutritionist of the latter half of 20th century. Although 95 may seem a rather advanced age, he was actively thinking about nutrition issues and writing his memoirs right up to the very end. Many economists were familiar with his work through his interactions with economists such as Robert Fogel, and from his service on the editorial board of EHB. Nevin was the founding director of Institute of Nutrition of Central America and Panama (INCAP) and lived in Guatemala from 1949-61. Subsequently, he joined the department of nutrition at MIT from where he retired in 1988 as an institute professor. Several obituaries have appeared in newspapers because food fortification programs that he devised for Central and South American and Asian countries improved the health of millions of undernourished individuals. For example, Incaparina is a cheap fortified gruel made with corn, sorghum, and cotton seed flour that helped in reducing protein deficiencies in the region. Nevin had a major impact on biomedical scientists’ thinking starting with his pioneering publication on nutrition and infection (Scrimshaw, Taylor and Gordon, 1959). The authors underscored the synergisms between individuals’ nutritional status and immunity to infections, i.e., chronically under-nourished individuals have lower immunity to fight infections, and repeated infections can worsen individuals’ nutritional status. This bi-directionality in under-nutrition and infection inspired some of my research since it presents a challenge for econometric estimation (Bhargava, 2008a). The purpose of this brief essay is to provide insights into the mind and workings of a great scientist whose primary objectives were to conduct rigorous research in nutritional sciences, and to devise and implement food policies for benefit of the poor. Remembrances I first met Nevin in 1995 in his office on Charles Street in Cambridge while visiting Harvard University. I had published a critique of the FAO/UNU/WHO (1985) publication on energy and protein requirements (Bhargava and Reeds, 1995). He was a signatory to that report and noted that many eminent nutritionists were consulted for producing the report. However, he added that their emphasis on defining energy requirements on the basis on energy expenditures in developing countries was wrong, as we had pointed out in the critique. This is because energy and nutrient intakes in developing countries are often inadequate to support high levels of labor productivity so that the observed energy expenditures are suboptimal. I was very impressed with his sincerity and from that point on we remained in close contact discussing and debating food and nutrition policy issues. He was always accessible and happy to receive my phone calls at anytime. I recall calling him in 1999 after he had cataract surgery; without knowing about the surgery, I asked him about an article available in the MIT library. He offered to walk to MIT to copy and fax the article to me with one eye bandaged! It took a lot of persuasion to stop him; I cannot think of another eminent scientist who at the age of 81 might be willing to perform such tasks for advancing scientific knowledge. While Nevin was elected to societies such as National Academy of Sciences, Institute of Medicine, and received the World Food Prize in 1991, he tried to minimize his achievements in part because he felt that scientists often waste their time on activities that do not serve larger interests of the society. In a sense, he was often trying to conceal his accomplishments. I recall meeting him at the 80th birthday party for Robert Fogel in 2006 in Chicago. We were in a discussion (“usual sparring”) about food policy issues   1

when we were asked to be seated at various dinner tables. When he learned that I was sitting at table number 7 and that he, according to the secretary “must be very important” to be seated at table number 1, he tried to get re-assigned to my table so that we could continue our discussion! For his own 80th birthday party in Cambridge in 1998, his former students who were by then eminent nutritionists paid tributes to him that touched him though only briefly. Subsequently, he started correcting the technical details in their presentations that he thought did not adequately reflect the knowledge in nutritional sciences. He expected very high standards from himself and from his students and collaborators. Future directions Nevin would have probably regarded this article as a waste of time unless it offers insights for research on food policy issues especially for young researchers; I will briefly try to summarize some of our research interactions. While Nevin was enthusiastic about food-based interventions starting with the longitudinal INCAP study supplementing children with protein enriched food (“Atole”) in Guatemala (Martorell and Scrimshaw, 1995), he also pioneered iron supplementation via tablets containing ferrous sulfate in a randomized controlled trial of rubber tappers in Indonesia (Basta et al., 1979). In the Indonesian trial, the authors found that higher iron intakes significantly improved the hemoglobin concentration and hematocrit levels of anemic workers. The improvements in iron status had significant benefits for labor productivity assessed by the quantity of latex collected by the workers. Furthermore, Basta et al. (1979) took a broader view of randomized controlled trials and noted that some individuals used the small side payments of $0.03 per day to buy foods such as vegetables that are a good source of vitamins A and C. The increased intakes of vitamins A and C, in turn, can enhance iron absorption which would also raise subjects’ hemoglobin concentration with some lags (Bhargava, 2008a, pp. 120-121). Several years later, we collaborated on these issues by modeling the proximate determinants of Bangladeshi women’s hemoglobin concentration taking into account nutrient interactions affecting iron absorption (Bhargava, Bouis and Scrimshaw, 2001). The insights of Basta et al. (1979) were also critical for my essay on the benefits and limitations of randomized controlled trials in developing countries (Bhargava, 2008b). For example, it is essential to model the pathways through which interventions affect various health outcomes. However, we differed somewhat in our emphasis on the nature of collaboration between biomedical and social scientists. For Nevin, it was important for nutritionists to work with social scientists to understand the cultural and socioeconomic aspects for formulation of efficacious food policies. However, I felt that social scientists are often wedded to their paradigms that can fluctuate over time so that one needs to place greater emphasis on the biomedical knowledge. My last interactions with Nevin were in 2011-2012 on the inadvertent effects of iron supplementation via tablets on increases in malaria morbidity and mortality among children in malaria endemic regions (Sazawal et al., 2006). Because malaria parasites can utilize iron from the tablets for multiplying, this was a situation where fortifying foods with small quantities of iron (~1 mg) was unlikely to be harmful especially in comparison with tablets that contain between 10-70 mg of ferrous sulfate (Bhargava, 2013). While Nevin had previously been an enthusiastic supporter of iron tablets, he started to change his views and revert to a position that he had previously adopted, namely, that long-term supplementation with fortified foods that households are familiar with was a sound and safe strategy. Moreover, he had been critical of iron absorption algorithms including those we had published (Bhargava, Bouis and Scrimshaw, 2001), and felt strongly for the need for conducting laboratory studies for improving their accuracy. Most researchers would be happy to have a few ideas left into their 90’s but Nevin never really stopped. The Indian playwright Kalidasa who lived in 4th century may have succinctly summarized Nevin’s personality in the couplet: The wise examine first and then decide; The fool makes up his mind by others’ views.   2

References Basta, S.S, Soekirman, M., Karyadi, D., Scrimshaw, N.S., 1979. Iron deficiency anemia and the productivity of adult males in Indonesia. American Journal of Clinical Nutrition 32, 916-925. Bhargava, A., 2008a. Food, economics, and health. Oxford University Press, Oxford, U.K. Bhargava, A., 2008b. Randomized controlled experiments in health and social sciences: Some conceptual issues. Economics and Human Biology 6, 293-298. Bhargava, A., 2013. Iron status, malaria parasite loads and food policies: Evidence from sub-Saharan Africa. Economics and Human Biology 11, 108-112. Bhargava A., Bouis H.E., Scrimshaw N.S., 2001. Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women. Journal of Nutrition 131, 758-64. Bhargava, A., and Reeds, P. (1995). Requirements for what? Is the measurement of energy expenditure a sufficient estimate of energy needs? Journal of Nutrition 125, 1358-1362. FAO/UNU/WHO (1985). Energy and protein requirements. World Health Organization Technical Series no. 24. WHO, Geneva, Switzerland. Martorell, R., Scrimshaw, N. (eds), 1995. The effects of improved nutrition in early childhood: The Institute of Nutrition of Central America and Panama Follow-up Study. Journal of Nutrition 125, Number 4S. Sazawal, S., Black, R.E., Ramson, M., Chwaya, H., Stoltzfus, R., Dutta, A., Dhingra, U., Kabole, I., Deb, S., Othman, M., Kabole, F.M., 2006. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: Community-based, randomized, placebo-controlled trial. The Lancet 367, 133-43. Scrimshaw, N., Taylor, C., and Gordon, J., 1959. Interactions of nutrition and infections. American Journal of Medical Sciences 237, 367-403.