Scientific priorities in North Korea.

In his Editorial “Talking with North Korea” (17 Sept., p. [1677][1]), N. P. Neureiter endorses the idea of scientific cooperation as a tool for engaging the isolated Democratic People's Republic of Korea. This view is echoed by R. Stone in his article “A wary pas de deux” (News Focus, 17 Sept., p. [1696][2]), and each recommends an approach that is both constructive and cautious. We agree but, along with caution, we recommend more urgency to the engagement process. The international and Korean scientific communities should first concentrate on still-widespread food insecurity and a largely dysfunctional health care system before turning its attention to such things as cloning rabbits or breeding supergoats, as mentioned in the article. Throughout the 1990s, North Korea experienced what even its leaders acknowledged was a “march through hardship,” including a famine whose most severe years were in 1996 and 1997. Up-to-date, empirical data on mortality were not permitted to be collected inside the country. It became necessary to adopt an indirect approach to data collection, which we did by interviewing a total of 2692 North Korean migrants and asylum seekers who had crossed into China in 1999 to 2000. In a retrospective household survey of the period 1995–98, we found evidence of elevated crude (all ages, all causes) mortality (peaking at 31.5 per 1000 in 1997), declining fertility, and rising out-migration ([1][3], [2][4]). About 35.8% of deaths (353 of 986) to the 9958 household members during the interval were linked to malnutrition and infectious disease, compared with 11.6% of deaths in 1986 ([3][5]). A health care system that once produced life expectancies and infant mortality rates comparable to those of South Korea on approximately one-tenth of South Korea's per capita GNP is now overwhelmed by a rising tide of communicable disease, scarce supplies of essential drugs, antiquated equipment, and shortages of heating fuel and electricity in the hospitals and clinics. In the face of these critical needs, North Korea is increasing some restrictions on foreign aid organizations working inside the country ([4][6]). Western scientists must join with colleagues in South Korea, China, and elsewhere in Asia to engage with our counterparts in North Korea to promote innovations in the agricultural and health sciences and many other fields, while understanding that North Korean scientists and intellectuals are an elite political class who derive their status and their livelihood from the state. Science to promote state prestige may be different from that which is in the immediate public interest. Engagement must seek to advance science in North Korea for the betterment of all its people. 1. 1.[↵][7] 1. C. Robinson 2. et al. , Pre-Hospital Disaster Med. 16, 4 (2001). [OpenUrl][8] 2. 2.[↵][9] 1. C. Robinson 2. et al. , Lancet 354, 291 (1999). [OpenUrl][10][CrossRef][11][PubMed][12][Web of Science][13] 3. 3.[↵][14] 1. N. Eberstadt, 2. J. Banister , The Population of North Korea (Univ. of California Press, Berkeley, CA, 1992). 4. 4.[↵][15] 1. B. Demick , L.A. Times “North Korea increases restrictions on foreign aid groups,” 30 Sept. 2004, p. A3. # Response {#article-title-2} I certainly have no disagreement with the priorities suggested for engagement with North Korea by Robinson, Lee, and Burnham. The only problem is that it takes two to tango. I recall that the United States discussed the general idea of exchanges with North Korea at the time of Secretary of State Albright's trip there—the idea was rejected by the North Koreans. The intriguing element of the present initiative is that North Korea has actually proposed the start of some cooperative scientific activity (“A wary pas de deux,” R. Stone, News Focus, 17 Sept., p. [1696][2]). If this is real and if they are truly prepared to follow up, I think we should accept this opportunity to begin meaningful cooperation with the North Korean scientific community. Until we have taken a first step toward a cooperative relationship in nonsensitive areas of science, I think it is not useful to try to dictate the priorities for their limited capacity to cooperate with us. [1]: /lookup/doi/10.1126/science.305.5691.1677 [2]: /lookup/doi/10.1126/science.305.5691.1696b [3]: #ref-1 [4]: #ref-2 [5]: #ref-3 [6]: #ref-4 [7]: #xref-ref-1-1 "View reference 1. in text" [8]: {openurl}?query=rft.jtitle%253DPre-Hospital%2BDisaster%2BMed.%26rft.volume%253D16%26rft.spage%253D4%26rft.atitle%253DPREHOSPITAL%2BDISASTER%2BMED%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: #xref-ref-2-1 "View reference 2. in text" [10]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DRobinson%26rft.auinit1%253DW.%2BC.%26rft.volume%253D354%26rft.issue%253D9175%26rft.spage%253D291%26rft.epage%253D295%26rft.atitle%253DMortality%2Bin%2BNorth%2BKorean%2Bmigrant%2Bhouseholds%253A%2Ba%2Bretrospective%2Bstudy.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252899%252902266-7%26rft_id%253Dinfo%253Apmid%252F10440306%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [11]: /lookup/external-ref?access_num=10.1016/S0140-6736(99)02266-7&link_type=DOI [12]: /lookup/external-ref?access_num=10440306&link_type=MED&atom=%2Fsci%2F307%2F5707%2F206.3.atom [13]: /lookup/external-ref?access_num=000081646000012&link_type=ISI [14]: #xref-ref-3-1 "View reference 3. in text" [15]: #xref-ref-4-1 "View reference 4. in text"