Public health, ethics, and functional foods

Functional foods aim to provide a positive impact on health and well-being beyond their nutritive content. As such, they are likely candidates to enhance the public health official's tool kit. Or are they? Although a very small number of functional foods (e.g., phytosterol-enriched margarine) show such promise in improving individual health that Dutch health insurance companies reimburse their costs to consumers, one must not draw premature conclusions about functional foods as a group. A large number of questions about individual products' safety, efficacy, and affordability need to be answered before they might become an important part of the public health agenda. More importantly, though, the costs and benefits of functional foods relative to alternative mechanisms of public health improvement need to be ascertained. Alternative scenarios that warrant investigation are mainly the supply of nutraceutical ingredients in pill form targeting "at risk" groups and consumer education on diet and lifestyle.