“Poverty is a business,” Patricia Wolff, a St. Louis pediatrician, said.

Could a Peanut Paste Called Plumpy'nut End Malnutrition? - NYTimes.com:

'via Blog this'We donned blue smocks, hairnets and booties and entered the sanitized factory floor, where two workers, a Burundian and a Liberian, were using scoops to weigh out portions of sugar. 


(That's not good.) Plumpy’nut production continues to take place at Nutriset facilities in France. (Unicef, the world’s primary buyer, purchases 90 percent of its supply from that factory, according to a 2009 report prepared for the agency.) 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 isPartners in Health, the charity co-founded by the prominent global-health activist Paul Farmer. 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. Peanuts in Haiti and throughout the developing world have a high incidence of aflatoxin, a fungus that can sicken children, especially fragile ones. But Partners in Health says the product, which it calls Nourimanba, is safe.

When I visited one of the charity’s outpatient clinics in July, 1-year-old Elorky Decena was silent and listless as a nurse hooked a scale over the clinic’s doorway and put him in an attached harness. A month before, he was found to have severe acute malnutrition, a condition characterized by extreme stunting and wasting that afflicts an estimated 20 million children worldwide. The nurse announced that he had gained more than four pounds on a diet of Nourimanba.

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.”

“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 Wolff complained mightily about the difficulties she faced because of Nutriset’s market dominance. “There’s money to be made,” she said, “and there are people who have that kind of way of thinking.” Two months later, Wolff made a tentative deal for Meds and Food for Kids to become a Nutriset franchisee. In the end, she said, she couldn’t afford to battle hunger on her own.

In the United States, Plumpy’nut’s sole manufacturer and chief promoter is a 38-year-old mother of four from Barrington, R.I. Navyn Salem doesn’t have a background in medicine or aid work. She first glimpsed the potential of Plumpy’nut three years ago on “60 Minutes.” Since then, Salem has devoted herself to making the product for export to needy nations like Haiti. Though her Providence factory, a joint venture with Nutriset, has all the trappings of a business, selling its wares to relief agencies under the name Edesia Global Nutrition Solutions, the operation is registered as a nonprofit foundation and was established with seed money from Salem and her husband, Paul, a private-equity financier. Dancing along the nebulous line between capitalism and charity, Salem casts herself as a marketer, offering a neatly packaged solution to a tragic and no longer intractable malady. On a Tuesday in May, she brought her message of good news to a Mother’s Day benefit in Midtown Manhattan.

“This is not my ZIP code,” Salem said as she stood in the East Side Social Club, a wood-paneled restaurant, amid a jostling crowd of bejeweled women pinching noontime flutes of Champagne. She met one of the party’s hosts, Lauren Bush, the former model and niece of the most recent ex-president, a couple of years ago at a conference of the Clinton Global Initiative. Now Bush and her mother, Sharon, were selling a specially designed line of teddy bears — a big one called Plumpy and a small one called Nut — to raise money to purchase the product for children in Africa.

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, 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. “There are over a billion people in our world that are malnourished,” Salem 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,” Salem 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.”

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 the prominent nutritionist Steve Collins. Salem’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. 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 Salem 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.