Food Politics

by Marion Nestle
May 5 2016

More on corporate funding of nutrition research: exchange of letters

In January this year, JAMA Internal Medicine published my Viewpoint on corporate funding of nutrition research: science or marketing.

Richard Kahn, former chief scientist and medical officer of the American Diabetes Association, wrote a letter in reply (see below for more about him**).  The journal published his letter, along with my response, in its current issue.  Here’s what I said.

In Reply Dr Kahn requests evidence that nutrition research funded by food companies is of lesser quality than studies funded by independent agencies or performed by investigators with nonfinancial conflicts of interest. Concerns about such issues are relatively recent; few published studies address them directly. Instead, concerns about industry sponsorship of nutrition research derive from comparisons with the results of studies of funding by tobacco, chemical, drug, or medical device companies. This research typically finds industry-sponsored studies to report results more favorable to the products of the sponsor than studies not funded by industry. It identifies subtle rather than substantive differences in the quality of this research; industry-funded studies are more likely to underreport unfavorable results and interpret neutral results more positively.1 When results are negative, they are less likely to be published.2

Between March 2015 and March 2016, I identified 166 industry-funded nutrition research studies and posted and discussed them on my blog.3 Of these, 154 reported results favorable to the interest of the sponsor; only 12 reported contrary results. The few studies systematically examining the influence of industry funding on nutrition research tend to confirm results obtained from other industries. For example, a systematic review comparing industry-funded and nonindustry-funded trials of probiotics in infant formula reported no association of funding source with research quality. Industry-funded studies, however, seemed more likely to report favorable conclusions unsupported by the data.4

Dr Kahn states that sponsored studies often specify that the funder had no role in the study. Only recently have some journals required such statements, and I am unaware of research on the extent of this practice or authors’ adherence to it. Among the 166 industry-funded studies that I reviewed, few disclosed involvement of a sponsor.

Dr Kahn asks whether industry funding is any more biasing than career self-interest or intellectual passion. Unlike industry funding, self-interest and passions are intrinsic to every scientist who conducts research, are a matter of public record, cannot be eliminated, and have not been shown to consistently bias research results in the same ways as industry funding.5 Fortunately, nutrition societies and research institutions are developing policies to manage financial relationships with industry.6 Such policies hold promise for preventing financial conflicts of research in nutrition research.

1. Lundh  A, Sismondo  S, Lexchin  J, Busuioc  OA, Bero  L.  Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2012;12:MR000033. PubMed

2. Rising  K, Bacchetti  P, Bero  L.  Reporting bias in drug trials submitted to the Food and Drug Administration: review of publication and presentation. PLoS Med. 2008;5(11):e217. PubMed   |  Link to Article

3. Nestle  M. Food Politics Blog. http://www.foodpolitics.com/. Accessed March 2, 2016.

4. Mugambi  MN, Musekiwa  A, Lombard  M, Young  T, Blaauw  R.  Association between funding source, methodological quality and research outcomes in randomized controlled trials of synbiotics, probiotics and prebiotics added to infant formula: a systematic review. BMC Med Res Methodol. 2013;13:137. PubMed   |  Link to Article
5. Bero  L.  What is in a name? Nonfinancial influences on the outcomes of systematic reviews and guidelines. J Clin Epidemiol. 2014;67(11):1239-1241. PubMed   |  Link to Article 
6. Charles Perkins Centre. Engagement with Industry Guidelines 2015. University of Sydney, 2015. https://intranet.sydney.edu.au/perkins/research-support/engaging-with-industry.html. Accessed March 2, 2016.
**Richard Kahn is infamous in my circles for supporting the positions of the sugar and soda industries while with the American Diabetes Association and now.  I wrote about what he said in an interview with Corporate Crime Reporter in my book What to Eat (pages 355-356).  Recently, The Russells (of CrossFit) had a lot more to say about Kahn’s ongoing opposition to public health measures.
May 4 2016

Big Ag forces firing of long-time Farm News cartoonist

I love cartoons (witness Eat, Drink, Vote: An Illustrated Guide to Food Politics) and was appalled when I read this tweet:

Here’s the offending cartoon:

In a Facebook post the cartoonist, Rick Friday, explained:

I am no longer the Editorial Cartoonist for Farm News due to the attached cartoon which was published yesterday. Apparently a large company affiliated with one of the corporations mentioned in the cartoon was insulted and cancelled their advertisement with the paper, thus, resulting in the reprimand of my editor and cancellation of It’s Friday cartoons after 21 years of service and over 1090 published cartoons to over 24,000 households per week in 33 counties of Iowa.

I did my research and only submitted the facts in my cartoon.

That’s okay, hopefully my children and my grandchildren will see that this last cartoon published by Farm News out of Fort Dodge, Iowa, will shine light on how fragile our rights to free speech and free press really are in the country.

The Des Moines Register explains further:

The CEOs at the ag giants earned about $52.9 million last year, based on Morningstar data. Monsanto and DuPont, the parent of Johnston-based Pioneer, are large seed and chemical companies, and Deere is a large farm equipment manufacturer.

Profits for the three companies, all with large operations across Iowa, also have declined as farm income has been squeezed. After peaking in 2013, U.S. farm income this year is projected to fall to $183 billion, its lowest level since 2002.

US Uncut adds more details:

Friday received an email from his supervisor at Farm News, informing him that he would be fired, citing he was “instructed” by a superior to not accept another cartoon from Friday. The supervisor told Friday that “in the eyes of some, Big Ag cannot be criticized or poked fun at.”

It also published Friday’s cartoons based on his firing.  Here’s one:

Friday has done other cartoons like this.  It’s not surprising that he has corporate advertisers upset.

How to help? Consider a quick note to Farm News about how badly Americans need a free, independent press to discuss farm issues.

Here’s the publisher’s contact information:

Larry Bushman
lbushman@messengernews.net

(Thanks to Daniel Bowman Simon for keeping me up on such things.)

Addition, May 5: Friday’s view of all this.

May 3 2016

How much is the soda industry spending to defeat public health?

Philadelphia Inquirer reporter Mike Newall says the beverage industry is spending a lot of money (“flowing like a Big Gulp”) to defeat the City Council’s soda tax initiative—$2.6 million so far (but see footnote below).

Here’s the catch – this time around, the beverage barons only have to win over City Council. There are 17 Council members, so that comes out to about $152,000 in ad dollars each.

Philadelphia is a battleground Big Soda cannot afford to lose.

The soda industry spent more than $10 million to fight soda tax measures in San Francisco (the industry succeeded) and in Berkeley (the industry lost—76% of voters were for the tax).

But what I really want to know is how much the soda industry spent to defeat Mayor Bloomberg’s proposal to cap the sizes of sugary beverages at 16 ounces.  I live in New York City and here’s what I saw the industry do or heard about (much of this is documented in my book, Soda Politics, and in former NYC Health Commissioner Tom Farley’s Saving Gotham; Farley is now health commissioner in Philadelphia):

  • Three full-page ads in the New York Times
  • Signs on Coke and Pepsi delivery trucks
  • A personal mailing to my home
  • Tee shirts: “I picked out my beverage all by myself”
  • People collecting signatures on petitions against the proposal (they said they were paid $30/hour)
  • Airplane banners
  • Movie trailers
  • Video ads
  • Meetings with city officials
  • Legal challenges—briefs, court appearances

This was not an election so the soda industry did not have to disclose how much it spent.  But I sure would like to know.

Footnote: Jim O’Hara of Center for Science in the Public Interest reminds me that he wrote a report last year about the amount of money spent by the soda industry to fight public health measures.  You can find it here.  By his count, the industry spent ~$15 million just in New York between 2010 and 2015, but I’m guessing this doesn’t count the soda cap legal fees.

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May 2 2016

At last! Menu labels in 2017!

Wonder of wonders, the FDA at last has issued its Final Guidance on Menu Labeling to go into effect a year from now.

Why astonishment?  New York City has had menu labeling since 2008. The national process started in 2010.

Here’s the chronology:

YEAR DATE ACTION
2010 March 23 President Obama signs the Affordable Care Act which includes a provision requiring chain retail food establishments with 20 or more locations to provide calorie information for standard menu items.
July 7 FDA publishes Federal Register notice soliciting comments and suggestions
Aug 25 FDA requests comments on “Draft Guidance for Industry: Questions and Answers Regarding Implementation of the Menu Labeling.”
2011 Jan 25 FDA withdraws draft implementation guidance; announces intent to exercise enforcement discretion until rulemaking process is complete; requests comments.
April 6 FDA issues proposed rule.
May 24 FDA issues document correcting errors in proposed rules; extends comment period.
July 5 FDA issues notice of proposed rulemaking.
2014 Dec 1 FDA issues final rule.
2016 April FDA issues guidance for industry.

Happily, the rules will cover:

bakeries, cafeterias, coffee shops, convenience stores, delicatessens, food service facilities and concession stands located within entertainment venues (such as amusement parks, bowling alleys, and movie theatres), food service vendors (such as ice cream shops and mall cookie counters), food takeout or delivery establishments (such as pizza takeout and delivery establishments), grocery stores, retail confectionary stores, superstores, quick service restaurants and table service restaurants.

Center for Science in the Public Interest has produced celebratory graphics:

It’s too bad we have to wait yet another year, but menu labels are worth the wait.

The FDA documents:

Apr 29 2016

Organic Life: Eight books about organic food systems

I did an interview last year with Rebecca Straus of Organic Life about books of interest to the magazine’s readers.  I never heard what happened to it but learned from a recent tweet that it is now available online.  So consider this a late catch up.

Marion Nestle’s Favorite Organic Books: Eight reads to get you thinking about where your food is coming from.  Organic Life, September 11, 2015.

Food advocate Marion Nestle, a professor of nutrition and food studies at New York University, has long been outspoken in her support of organic farming and opposition to GMO crops. Her books and articles on how science, marketing, and society impact food choices and obesity have influenced everyone from Michelle Obama to Michael Pollen, who named her the second most powerful foodie in America.  Her new book Soda Politics: Taking on Big Soda (and Winning), comes out in October. But even when she’s busy writing, Nestle takes time to review other recent titles on her popular blog, Food Politics. “I’m overwhelmed by the avalanche of outstanding books that I run across or that get sent to me,” she says. But when forced to choose, she settled on these eight as some of the best writing and original research in the bunch, adding, “They deserve much more attention than they’ve received.”

Food, Farms, and Community: Exploring Food Systems by Lisa Chase and Vern Grubinger

“Many people don’t understand what food systems  are, and it’s very hard to explain, so this book is a terrific introduction. The authors take a big-picture approach to explain how our food gets from production to consumption,.They also focus on how we can create food and farming systems that promote the health of people and planet. It’s very readable.”

The End of Plenty: The Race to Feed a Crowded World by Joel K. Bourne, Jr.

“This book takes a look at industrial farming and discusses how food production must change to meet the world’s demands. But if you think the title sounds depressing, you shouldn’t.  The food situation is so much better than it was 20 years ago. There’s so much more organic, local, and seasonal growing. Students are interested in these issues, and that’s inspiring to me. You can make progress without overturning the whole system. My personal measure is that when we started food studies at NYU in 1996, we were the only program like that in the country. Now every university offers food studies and has an organic garden.”

From Field to Fork: Food Ethics for Everyone by Paul Thompson

“Ethical dilemmas impact the way we shop for food. Should we buy orancic or local? Should we care how farm animals are raised? For people who aren’t trained in ethics, it’s sometimes hard to think about these things, and this book can help you delve into them.”

Organic Struggle: The Movement for Sustainable Agriculture in the United States by Brian K. Obach

“For me, the discussion of the development of the organic standards is the most interesting part of this book. It explains why it’s so important to maintain strict organic standards, and why there’s such intense conflict about them. In fact, the biggest issue facing the organic industry is confidence in the standards.”

Afro-Vegan: Farm-Fresh African, Caribbean & Southern Flavors Remixed by Bryant Terry

“Terry is an extraordinary cook. He’s really concerned about the health of African Americans, who tend to have much higher levels of chronic disease, so he sets out to demonstrate that it’s possible to cook a healthier, vegan diet using the ingredients of traditional African cuisine, like collards, grits, and okra. I’ve never seen a book like this before.”

Lentil Underground: Renegade Farmers and the Future of Food in America by Liz Carlisle

“Carlisle is an incredible author (and Michael Pollan’s protégé). To write the book, she simply went to talk to farmers in Montana to find out what they were doing. It’s very lively. I attended her book tour, and she actually brought the farmers with her – it was clear she was really passionate. Everyone is always talking about how farmers are failing, but this is a success story. It’s inspiring.”

Breadlines Knee-Deep in Wheat: Food Assistance in the Great Depression by Janet Poppendieck

“I have special interest in this one – I wrote the foreword. The author is fabulous, and this book is particularly well done. Anyone who wants to really understand the Farm Bill and the fight about food stamps needs to read this book. We’re seeing enormous congressional fighting over SNAP right now, and those same issues were there from the very beginning.”

Lethal but Legal: Corporations, Consumption, and Protecting Public Health by Nick Freudenberg

“This book is compelling because it draws out the parallels between food issues and things like cigarettes, guns, and alcohol. Food producers use the same corporate strategies as these other industries to enrich themselves at the expense of public health. I believe advocacy is the only way to beat the system, and Freudenberg writes about ways for organizing against coporate power to create a healthier environment.  organize against corporate power for a healthier, more sustainable environment.”

Apr 28 2016

The Guardian’s article on the “sugar conspiracy”

I mentioned yesterday that whenever something comes out saying that “everything you thought you knew about nutrition is wrong,” it’s a sign that some skepticism may be in order.

Here is another example: The article on the “sugar conspiracy“ by Ian Leslie published in The Guardian.  This strongly criticizes the work of Ancel Keys, whose work was largely but by no means exclusively responsible for the diet-heart hypothesis linking excessive intake of animal fats to heart disease risk.

I love conspiracy theories as much as anyone else and appreciated how the author made his case for this one.  My sense of his article was that it had grains of truth (Gary Taubes and Cristin Kearns, for example, report that Keys had funding from the sugar industry).  But the overall thrust of the article seemed excessively hyperbolic and based on selective picking of the data (cherry-picking).

Going through the piece line by line to identify errors and misinterpretations was not something I thought worth the trouble.

Fortunately, someone else did.

Katherine Docimo Pett, a master’s degree candidate in biochemical and molecular nutrition at Tufts University, who blogs as Nutrition Wonk, sent me her detailed critique of the paper.  She explains:

So I decided to look into the Seven Countries Study and I found a number of occasions where “The Sugar Conspiracy” misinterprets the evidence.  So buckle yourselves up, conspiracy theorists, because in this post, I’m going to cover the history of the diet-heart hypothesis – namely The Seven Countries Study and the subsequent research mentioned in “The Sugar Conspiracy.”

If you can wade through her lengthy analysis, you will be hard pressed to disagree with her conclusion:

In “The Sugar Conspiracy,” the author makes a lot of assumptions about intent, the usefulness of epidemiology, and even the conclusions of papers.  However, upon closer inspection, a lot of his evidence doesn’t hold up under scrutiny.

The idea that Keys claimed in his Seven Countries Study that correlation proved causation is false.  Keys just said that cholesterol is a mediator for heart disease and that saturated fat raises cholesterol, both of which later turned out to be true.  The Menotti “reanalysis” did not find that sugar is more closely correlated with heart disease than fat, and even if it did, it is a simple regression – it controlled for zero confounders, way fewer than were controlled for in the original Seven Countries Study.  Finally, there is plenty of evidence to suggest that substituting saturated fatty foods in favor of unsaturated fats is a good idea [Clarification: she must mean substituting unsaturated for saturated].

It is absolutely worthwhile to debate the merits of all scientific findings or even the merits of an entire field, like epidemiology.  Scientists, even nutrition scientists, do this all the time.  The problem, though, is that if basic facts are actually based on misinformation, you can’t build a real case for or against anything.

Amen.

Footnote: Sarah Tracy, an historian at the University of Oklahoma, has been working on a biography of Ancel Keys for quite some time.  I can’t wait for her to get it done (she probably can’t either), as it is likely to give us a thoughtful, balanced account of the significance of his work.

Apr 27 2016

The fuss over previously unpublished data from the Minnesota Heart Study

A couple of weeks ago, I mentioned several new studies that elicited much media attention.  I am now getting around to them.

Let’s start with the article in the BMJ about newly discovered data from the Minnesota Heart Study purportedly casting doubt on the risks of saturated fat (here’s what the Washington Post said about it).

The BMJ article concluded:

Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

I’ve been at this game long enough to guess that any statement suggesting that everything you thought you knew about nutrition is wrong ought to raise red flags and call for more than the usual degree of skepticism.

Here are some sensible and, yes, skeptical comments about this study:

From Julia Belluz of Vox

But there were a few major problems with the research. The study involved men and women of an average age of 52 who had been admitted to a nursing home and six state mental health hospitals because they were sick. The researchers who conducted the meta-analysis note the “results are not necessarily generalizable to populations without mental illnesses or living outside nursing homes.”

Another issue: The study followed 9,423 women and men, but only a quarter of the participants followed the diets for more than a year. Altering one’s diet for a short period of time — especially in old age — would not necessarily affect one’s long-term health risks….

…Some of the biggest controversies surround saturated fats. Scientists disagree about the extent to which saturated fats contribute to important health outcomes like heart disease, stroke, and cancer. The available research does suggest, however, that there are health benefits from replacing saturated fats with unsaturated fats in the diet, and that eating lots of nutrient-poor carbs (like sugary cereals, soda, and white bread) instead of fat is a bad idea.

From David Katz, to whom I am often grateful for taking on such things, writes that this study

tested something that nobody expert in nutrition is recommending: an extremely high dose of omega-6, linoleic acid…we already got the memo that this is a dubious proposition.

With all due respect to the BMJ authors, I personally found it a bit odd that they stated the following: “A key component of dietary guidelines has long been to replace saturated fat with oils rich in linoleic acid…” The current Dietary Guidelines for Americans, let alone the far better 2015 Dietary Guidelines Advisory Committee Report, make no such recommendation. Searching for any mention of linoleic acid, I found it only in the appendices in the context of descriptions and definitions, not in any of the actionable guidance. While the current Dietary Guidelines do recommend limiting saturated fat intake, the replacement encouraged is a balance of healthful oils, such as olive, and the fats found natively in, as noted, nuts, seeds, avocado, and fish.

From Martijn Katan, the Dutch lipid biochemist who did the original work demonstrating the cholesterol-raising effects of trans fats, writes in an e-mail:

I have not had time to study the BMJ article on the Minnesota Heart Study in detail. However, some of my colleagues did, and I think that their conclusions are correct:

  1. The randomized trial itself showed no effect on disease or death
  2. This was to be expected because most subjects were on the diet for less than 1 year. This was due to the change in regime for psychiatric patients that took place during that period, which essentially caused the trial to fail. Lowering cholesterol by 14% for one year does not noticably affect CVD risk.
  3. The relation of a larger fall in cholesterol with a larger risk of mortality did not emerge from the randomized study; subjects were not randomized to various levels of cholesterol lowering. It is an observational association. The question than arises which causes which. Various occult diseases, notably cancer, cause cholesterol to fall as the disease progresses. This also explains the association seen in observational studies between low cholesterol and cancer. That observation led me to think up in 1985 the technique now known as ‘Mendelian Randomization’ [1]. Application of that technique showed that the association of low cholesterol and cancer is indeed spurious [2].

The only new thing about the present study is that they revived the long disproved hypothesis that lowering cholesterol causes various diseases. Hundreds of thousands of patients in statin trials have proven this wrong….

[1] Katan, M.B., 1986. Apolipoprotein E isoforms, serum cholesterol, and cancer. Lancet 1, 507–8.

[2] Trompet, S.,et al ., 2009. Apolipoprotein E genotype, plasma cholesterol, and cancer: a Mendelian randomization study. Am J Epidemiol 170, 1415–21.

My bottom line on this one

It confirms the value of basic dietary advice: Eat a variety of relatively unprocessed foods, mostly plants (fruits, vegetables, grains, beans, nuts), balance calories, and enjoy what you eat!

Do this and food fatty acids will balance out too and you won’t need to give them another thought.

The moral

Whenever you read a headline suggesting that everything you know about nutrition is wrong, roll your eyes, eat something delicious, and wait for confirming studies to come along before deciding to ignore that basic advice.

Apr 26 2016

Soda Politics gets Presidential: Sanders v. Clinton on soda taxes

Talk about soda politics! I can hardly believe it but soda taxes have become an issue in the Democratic primary campaign.

This started when Hillary Clinton came out in favor of Philadelphia Mayor Jim Kenney’s proposed soda tax.

I’m very supportive of the mayor’s proposal to tax soda to get universal pre-school for kids. I mean, we need universal pre-school. And if that’s a way to do it, that’s how we should do it.

Given the Clinton Foundation’s long-standing relationship with Coca-Cola, this was unexpected.

In short order, Bernie Sanders distanced himself from her position:

I do not support Mayor Kenney’s plan to pay for this program with a regressive grocery tax that would disproportionately affect low-income and middle-class Americans. I was especially surprised to hear Hillary Clinton say that she is “very supportive” of this proposal. Secretary Clinton has vowed not to raises taxes on anyone making less than $250,000 per year. For reasons that are not clear, she has chosen to abandon her pledge by embracing a tax that targets the poor and the middle class while going easy on the wealthy. That approach is wrong for Philadelphia, and wrong for the country.

This, in turn, induced Paul Krugman, who seems to have little love for Sanders anyway, to weigh in:

It does seem worth pointing out that progressivity of taxes is not the most important thing, even when your concern is inequality. Notably, Nordic countries — very much including Denmark, which Sanders has praised as a model — rely heavily on the VAT, which is a regressive tax; but they use that revenue to pay for a strong social safety net, which is much more important.

If we add in the reality that heavy soda consumption really is destructive, with the consequences falling most heavily on low-income children, I’d say that Sanders is very much on the wrong side here. In fact, I very much doubt that he’d be raising the issue at all if he weren’t still hoping to pull off some kind of political Hail Mary pass.

Soda tax proponents wish that Sanders had better understanding of the health issues.

Proponents say Diabetes is regressive.

Here’s information from the table from Soda Politics on framing the soda-tax debate (see page 385).

OPPONENTS SAY ADVOCATES SAY
Taxes are a blunt instrument of government intervention. Taxes can encourage healthier food choices while generating needed revenue.
No compelling evidence links sodas to obesity or other health problems. Research sponsored by independent agencies, not soda companies, clearly links soda consumption to overweight and poor health.
Soda taxes are regressive. They disproportionately hurt poor people. Diabetes is regressive. Obesity and diabetes disproportionately hurt poor people.
Governments should stay out of personal choice. Governments should protect the health of citizens.
Soda choice is a matter of personal responsibility. Taxpayers fund health care costs. Obesity and diabetes are matters of social responsibility.
Soda companies are already making healthful changes to their products. Soda companies heavily market sugary beverages.
Soda sales have declined while obesity rates remain high; Sodas cannot be responsible for obesity. Obesity rates are stabilizing as soda sales decline. Sales of some other sweetened beverages are increasing. All should be taxed.
Sodas are not cigarettes or alcohol; They do not cause the same level of harm. The health effects of sodas increase health care costs for everyone.
Soda taxes lead to unintended consequences; Decreases in consumption will be offset by other sources of calories. Cigarette taxes decreased smoking; Let’s try taxing sodas and see whether it works.
Everyone opposes nanny-state soda taxes. Soda taxes linked to health programs have strong bipartisan support from public health organizations, city officials, and policy centers.
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