by Marion Nestle
Jan 24 2013

An open letter to Registered Dietetians and RDs in training: response to yesterday’s comments

My post yesterday about Michele Simon’s report on food company sponsorship of the Academy of Nutrition and Dietetics (AND) elicited a wealth of thoughtful comments.  These are well worth careful consideration.

Many express disappointment that I would suggest that corporate sponsorship might influence their thinking or practice, that other nutrition professionals have equal or better education, that I singled out AND when other nutrition and health organizations also accept food industry funds, or that I am unsympathetic to their plight (they are required to be AND members whether or not they agree with its policies).

Let me clarify:

On the effects of corporate sponsorship: I don’t know a single individual who thinks that taking money from food companies influences personal opinion or practice, but research on the effects of drug—and food—company sponsorship demonstrates otherwise.    At the very least, sponsorship gives the appearance of conflict of interest.  Individuals and organizations who accept sponsorship from soda companies, for example, can hardly be expected to advise the public to drink less soda.

On education: my point here is not that dietetic education is inadequate but that other nutritionists without such training may be equally qualified to advise the public about diet and health.

On other organizations:  That other nutrition and health organizations accept funds from food companies has long been a point of discussion on this blog (click on Partnerships).  I am especially concerned  about the practices of the American Society of Nutrition, to which I belong.  Its embarrassing role in the Smart Choices fiasco was an example of why nutrition professional organizations should avoid getting involved in such alliances.

On sympathy: I have plenty.  Food company sponsorships create painful dilemmas for nutrition professionals and each of us must figure out our own way to deal with them.  I have written about my own struggles with this issue in Food Politics and elsewhere.

I especially appreciate the comments from those of you engaged in your own struggles with this issue within AND.  You have your work cut out for you.  Here, for example, is the response of your president, Dr. Ethan Bergman, to Simon’s report. He writes [and see addition below]:

There is one indisputable fact in the report about the Academy’s sponsorship program: We have one. And for the record, I support the Academy’s sponsorship program, as does the Board of Directors and our members.

Let me make it clear that the Academy does not tailor our messages or programs in any way due to influence by corporate sponsors and this report does not provide evidence to the contrary.

…As members of a science-based organization, I encourage you to not take all information you see at face value, always consider the source (in this case, an advocate who has previously shown her predisposition to find fault with the Academy) and seek out the facts.

My interpretation: ignore the message because the messenger is not one of us.

As nutrition professionals, we ignore such messages at our peril.  If we want the public to trust what we say, our views cannot be perceived as compromised by financial ties to food companies.

What you can do.  If, as some of you noted, you oppose corporate sponsorship and would like to do something about it, here are a few suggestions:

  • Let your voice be heard: write letters, post blogs, send tweets.
  • Make it clear to colleagues and clients that you oppose current policies on corporate sponsorship.
  • Provide evidence that your organization can do just fine without the money.
  • Join committees and groups within your organization; say what you think.
  • Organize petition campaigns.
  • Run for office; run a slate for office.

If you want the policy to change, work for it.

But don’t be discouraged if nothing much happens right away.  Change takes time.  Keep at it.

Thanks to all of you for taking this issue so seriously.  Let’s keep working together to find ways to keep food company money out of our professional lives.

Addition, January 25: a reader, Craig, points out that Coca-Cola gave Dr. Bergman the opportunity to carry the torch at last summer’s Olympic games.  A news story about this event quotes Dr. Bergman on the Academy’s partnership:

I think the philosophy that Coca Cola has through its Live Positively campaign, and our philosophy at the academy, is about trying to improve the nation’s health through better nutrition and fitness so this fits in well with our cause.

 

Comments

Thank you, Dr. Nestle, for pointing out that critiques of AND’s troublesome corporate sponsorships are not “RD bashing”, but an important piece of the conversation regarding a systemic flaw that threatens the credibility of all dietitians in the eyes of the general public.

I point any of my colleagues who took offense to yesterday’s post to this sentence: “At the very least, sponsorship gives the appearance of conflict of interest. Individuals and organizations who accept sponsorship from soda companies, for example, can hardly be expected to advise the public to drink less soda.” We can not pretend that partnering with the likes of Coca-Cola and PepsiCo doesn’t affect the stances our professional organization takes on soda. To dismiss such a concern by referencing your own critical thinking misses the larger point — many RDs and RDs-to-be view these partnerships as their organization validating and approving of those companies’ products and actions.

Lastly, thank you for suggesting steps that RDs unhappy with corporate sponsorship in AND can take to begin to remedy the problem. It’s great to have you as an advocate for greater transparency.

  • Stephanie Goodwin
  • January 24, 2013
  • 10:50 am

Thank you for the considerate response Marion. It is well said and I appreciate that many of us are working towards similar goals.

  • Courtney
  • January 24, 2013
  • 11:36 am

corporate sponsorship of professional organizations is not new and an end all. Check out any sponsors of other professional organizations….or check out the sponsors of any sort of medical “research” which is listed in verrryyy small print that it is supported by a drug company that wants a specific outcome published in journals. The bottom line seems too often to just be a dollar sign. credibility is solely based on who corporate sponsors of an organization are.

  • Courtney
  • January 24, 2013
  • 11:37 am

credibility ISN’T* solely based on who corporate sponsors of an organization are.

  • kathy
  • January 24, 2013
  • 11:48 am

I agree with the prior comments and also thank Dr. Nestle for provdiding a forum for dicussion about AND’s corporate sponsorships.
Personnally, I believe AND is creating a “perfect storm” by partnering with these companies….. while providing barriers to registration to many qualified individuals ….while our obesity/daibetes rates are soaring.
Don’t believe for a second that these corporations care about the health of Amercia ! Their business model is to make a profit and AND is helping them do just that..

  • Kay
  • January 24, 2013
  • 12:27 pm

Thank you Marion. Many, many, many RDs agree with you. AND has taken the position of accepting money from junk food companies and then stating there is no conflict. REALLY hard to swallow for many RDs. They have NOT listened to thier members; maybe they will listen to you.

Further, AND does not follow their own policy of being science-based at the annual meeting – even when they’ve been informed.

Thank you for being vocal. I wish more RDs would do the same.

Kay

I appreciate Michele Simon’s report exposing AND’s unsavory sponsorships which threaten dietitians’ credibility. However, in the name of full transparency I am curious to know who or what organization sponsored her report, their sources of funding, and their motives.
I appreciate Dr. Nestle’s suggestions for positive change. Sponsorship is clearly an issue that threatens many professional organizations.

  • Mindy
  • January 24, 2013
  • 6:35 pm

Marion & fellow RD’s: We are between a rock and a hard place right now in our history as nutrition scientists. It is important to take the road of independence, free of corporate sponsorship. It will be a difficult pill for us to swallow. I would prefer AND continue to spend their effort on marketing RD’s as the quality trained nutrition specialist.

  • Nnuola
  • January 24, 2013
  • 7:28 pm

It is not surprising to find this practice – it is common among many practicing health and wellbeing. Medical doctors, dentists, pharmacists etc. are often guilty of being involved with by corporate sponsors so it shouldn’t be a surprise that health and wellbeing practitioners are also susceptible to these influences too.

While it is hard to maintain independent views and practice with corporate sponsorships, it is not impossible. After all there are corporations that make products that are good for our health. It just depends on “who” and “what” they are selling to the public.

  • Michele Simon
  • January 24, 2013
  • 8:42 pm

Melinda,

As you know, I have been exposing corporate ties such as these for years. I have many different clients, as I explain on my website: http://www.eatdrinkpolitics.com/about/

  • Craig
  • January 25, 2013
  • 8:39 am

Marion: It’s easy to see that food companies have been good to Dr. Bergman. Coca-Cola gave him the opportunity to carry the torch at the Olympic Games this past summer. http://www.thisishampshire.net/news/9664077.American_to_carry_torch_for_Coca_Cola/

The head of a nutrition organization running a torch for peddlers of sugary drinks in honor of athletic prowess and health? Sounds like Food Politics in action!

  • Pau Kobulnicky
  • January 25, 2013
  • 9:35 am

Marion … I am not a dietician but I am a professional who has been a member of several professional organizations. EVERY profession has this dilemma with the pernicious effects of corporate sponsors. Let me help to frame the dilemma in black and white. They give us money. If it were not for sponsors, we the members would have to pay A LOT more for our conferences, meetings, publications, educational efforts, digital networks, and on and on. We not only take their money but we actively solicit it. How long would they give us money of we were indeed critical of them? So, we bite our tongues; hold our thoughts, couch our terms. Again, this is not unique to AND. To quote on of the best bits of dialog from The Wire, “Conscience do cost”.

This is a challenging topic for sure.

However, two points:
1. most often it is the educational foundations of the companies sponsoring events to education foundation of AND;, and both they and AND have strict rules relating to the independence/autonomy of each.
2. also RDs are not required to be members of AND; they are required to affiliate with the Comission on Dietetic Registration, which is separate from AND in order to be credentialed as an RD.

  • Cathy RD
  • January 25, 2013
  • 5:46 pm

Even if AND members aren’t influenced by the corporate sponsors, I can almost guarantee that AND is influenced. Being from Canada, I know of one Canadian association for dietitians that modified their statements on sugar and on genetic modification due to corporate sponsors sensitivity to how things were worded. I believe Marion calls it “Food Politics”. Hmm. It’s not just her theory, or conspiracy theory, it’s a fact that this happens.

As an individual RD I rely on my associations’ position statements and briefs to get backing for my projects at work. You can imagine how hard it was to get schools and hospitals to listen to my sugary-pop-isn’t-healthy when my professional association said sugar could be enjoyed in moderation with no ill effects.

After failing to get the association to update their sugar info, I quit my membership, with a letter explaining why, and made my concerns pretty well known to other members in my region. A few others quit. And the association listened, finally.

Conflicts of interest have to be taken very seriously. When financial tough times hit, a strong position statement on sponsorship can help keep the ship on course. Apparently AND does not have this.

Members can sway their organizations. But you must persevere, and talk tough sometimes.

  • mila
  • January 25, 2013
  • 7:57 pm

Although it’s true that other nutritionists are qualified to advise the public on general health and nutrition, RDs are uniquely qualified to give advise to those with chronic (disease) conditions.How many times have we heard the so called “nutrition experts” recommend vegetable juicing/ megadose fish oil supplement for a heart patient on a blood thinner?

If the average “corporate sponsorship” line of AND’s annual financial statement represents between 5-8% ($1.8M-$2.9M, respectively) of total revenue and has about 74,000 members, wouldn’t an extra $42-$392 (respectively) in dues per member negate the necessity of having such sponsorship?

This excellent expose by Ms. Simon reminds me of the American Diabetes Association recently naming Domino Sugar as “Strategic Partner of the Year” (https://dominosugar.com/media/domino-foods-inc-named-national-strategic-partner-of-american-diabetes-association). I’m just making a wild guess here, but I doubt the ADA will be reducing their recommendation for sugary intake for diabetics anytime soon, at least not any quicker than AND will change their tune on soda.

I’m not an RD or nutritionist, but it seems given the systemic and inherent conflicts of interests that abound in the general area of health (Marion’s blog and books document a good deal of this; others in this thread have already pointed out doctors and Pharma), health is too important to be the sole domain of any single profession, including RDs.

People really have to be their own best independent advocate when it comes to looking out for their health.

  • Jessica
  • January 26, 2013
  • 4:11 pm

A Registered Dietitian is uniquely qualified to prevent, treat, and manage nutritional diseases among the population. RDs are REGULATED, health professionals. In Canada, at least, we must go through a 4 year undergraduate degree and obtain a highly competitive 40-50 week internship. The success rate in 2012 was only 32% across Canada. I enjoy your blog but it was a shame to read you think others are just as qualified to advise the public about diet and health. I agree there are others, like yourself, that are quite knowledgable about nutrition but an RDs educational training gives them unique knowledge that the public can trust to get information from.

  • Mary Dean
  • January 26, 2013
  • 8:09 pm

I’m still disheartened at the comments you made regarding the RDs knowledge in Nutrition Science and ability to critically think.

Your Previous Comment:

“For one thing, nutritionists with master’s and doctoral degrees are likely to know more than RDs about nutrition science and to think more critically about it.”

Your recent comment:
“On education: my point here is not that dietetic education is inadequate but that other nutritionists without such training may be equally qualified to advise the public about diet and health.”

Perhaps an admission that you wrote your sentence incorrectly is in order — if that is the case. But instead all you say is that other “nutritionists” you don’t specify MS or PhD trained in nutrition are as qualified.

I have my RD. I earned my MS degree doing research on nutrient transporters in the GI tract and my PhD degree at another institution doing applied research examining the effects of Very-Low Carbohydrate diets on Bone. I’d like to think I’ve got a wide range of experiences in research. My Dietetic Internship furthered my training in critical thinking in a broader scope: I learned how to critically think in terms of management, motivating a client to adhere to nutrition recommendations, and to critically think about the nutrition science and how to translate the technical terminology into day to day terms that an individual with no more than a high school education can understand.

What I learned from getting my MS degree and PhD degree was that while that training helped me to better critique and evaluate scientific literature, my knowledge increased only in a very specific area. My impression of individuals who earn their PhDs in other disciplines and then work their way into faculty positions in nutrition really don’t appreciate the breadth of training that RDs have and that their knowledge of nutrition is very narrow within their area of research. And they rarely broaden their scope. I see it where I currently work in a Division I research institution. I wonder if, perhaps the Registered Dietitian has done such a good job at translating the science to the layperson rather than use technical language to disseminating the information that individuals with their PhDs without the RD think those with only the RD credential can’t critically think.

The PhDs who are narrowly focused in their area of research constantly use highly technical language that is not understandable to most people. In the past 10 years the push by NSF and NIH and other government organizations is “translational” research. Something RDs have been doing all along.

I think we can all identify people in both areas who know a lot of information and those who only know a very specific set of information. I think to generalize it for either group is a mistake.

  • Leslie
  • January 27, 2013
  • 5:11 pm

As a RD I am very concerned with the direction of the AND. They try to frame the corporate relationship with Coca-Cola, Pepsi, Mars, etc as having a seat at the table and influencing new products, while completely ignoring the obvious conflict of interest. Corporations respond to consumer demands and in recent years it has been consumers, not the AND, to demand low-calorie and 0 calorie beverages.

The fact is the majority of RDs do not and never will recommend coke, pepsi, or other forms of junk food. But our professional association has no problem taking money from these company’s and advertising their products or even providing education for it’s members. Not many people are aware of this but the Academy’s membership has been in decline for several years and will likely continue to decline if they do not listen to what it’s members concerns are, what the pubic is saying, and will not recognize the obvious and blatant conflict of interest of having a junk food company as a corporate sponsor.

It seems as though the Academy is trying to please everyone and welcome all to its organization. When really they should be concerned about its real mission of enhancing the health of the public and serving it’s members. If that means telling coke to take a hike and that we do not support the consumption of junk food, especially with the epidemic of obesity in the US then so be it.

I’m afraid if they do not do something to improve its public image and do not really listen to their members the AND will become a dinosaur and have no influence on public health. Sure RDs will likely always be the experts when it comes to clinical nutrition but so far we are losing the battle to win the hearts and minds of the public.

  • Amy
  • January 27, 2013
  • 10:12 pm

I find this conversation to be very interesting. It’s good to know that not all RDs are members of AND or support their corporate sponsorship practices. I am currently studying to be a nutritional therapy practitioner. I believe that my education will make me a qualified nutrition professional, but unfortunately licensing laws across the country are becoming stricter about who can provide nutrition advice. I agree some oversight is needed, but many of the committees who determine the licensing laws are influenced by the AND.

Marion, I appreciate your clarification on this issue but still take exception on the point “,,,other nutritionists without such training may be equally qualified to advise the public about diet and health” in regards to dietitians versus nutritionists. There are lots of folks out there right now who are eager to give advice about diet and health…nurse, physicians, chiropractors and of course people who call themselves “nutritionists” but may not even have a college degree or any practical experience in nutrition. Even if I wasn’t a registered dietitian who would I want to get nutrition advice from about a diabetic diet? A dietitian whose worked in a hosptial and counselled hundreds of diabetics, attended continuing education on diabetes, has taught carbohydrate counting, and is perhaps a certified diabetes educator or maybe a clerk behind the counter at my local health food store who calls herself a “nutritionist”, listens with concern as I tell her my latest blood glucose test was a little elevated and then proceeds to tell me to use agave syrup instead of the “poisonous” white sugar and tries to sell me handfuls of supplements.
The most important message you have here for dietitians is to stop merely complaining on social media about AND. WRITE to AND and tell them you’re willing to pay more in membership for less sponsorship; SERVE on a committee, RUN for office in your state dietetic association…

  • Annette Presley
  • January 28, 2013
  • 10:29 am

I am a registered dietitian who disagrees with most of what I was taught about nutrition after spending a year pouring over the research on saturated fat and cholesterol from the 1950s to the present. I can tell you, after looking at the actual data, that the AND is not science based when it comes to saturated fat and cholesterol. Our views on that subject have been influenced by the food and drug industry. They make a lot of money on our fear of fat.

If we are to be truly science based, then we need to objectively look at all the science, not just the studies that seem to support the view we want to take. I’ll give an example.

The 7 countries study is one of 3 studies the AND uses to support their view of saturated fat and cholesterol. Ancel Keys conducted this study. He handpicked 7 countries and plotted on a graph the amount of fat available for consumption and the number of deaths from heart disease. He was able to produce a perfect line so that the more fat available, the more deaths. The problem is that at the time he conducted this study, data was available for 22 countries and if you put all 22 countries on the graph, there is no correlation between available fat and deaths from heart disease. Also, had he picked a different set of 7 countries, he could have shown the exact opposite effect; the more fat available, the fewer deaths from heart disease.

What was entirely ignored in this study was iodine and vitamin D. The Japanese have lower rates of heart disease, but a higher iodine intake. In Finland, one of the countries picked by Keys, two cities were pretty identical in the amount of available fat but they had very different rates of death. The city with the fewer deaths had a higher iodine intake. And the countries that were farther north had more deaths which might be due to lack of vitamin D rather than fat intake. I saw an iodine thread in every type of study conducted on saturated fat and cholesterol, but we never hear about iodine in relationship to heart disease. Could it be that iodine can’t make money for the drug industry so they don’t bother with it?

My point is that if we are to be science based, we need to actually look at the science and all the variables, not just one. I had to battle the AND for my credentials and in that battle, the “experts” refused to address the science and, instead, attacked me personally. I fail to see how we can claim to be science based when we refuse to address the science. What are we afraid of? The truth?

As a dietitian, I don’t care what the truth is, I just want to be able to give advice that is based on truth, advice that truly is science based and reflects the actual data. Advice that will truly help my clients. We’ve been doing the food guide pyramid, low fat diet for over 30 years and in that time we’ve seen a huge increase in obesity. Our advice isn’t working. Perhaps it’s time we shed our pride and take an honest look at the science. I just don’t think the food and drug industry would support that.

  • Cathy RD
  • January 28, 2013
  • 3:17 pm

Annette — Yes! Thank you. One reason RDs get a bad name is because they persist in being fat paranoid, and people just have too much trouble finding a palatable and achievable way to eat and prepare food daily when it’s too low in fat. This paranoia fed into a food supply that is too heavily reliant on sugars and carbs. To some degree, the obesity epidemic is a result of dietitians perpetuating the fat myth.

For a really interesting perspective on this, CBC did a great series on Cholesterol Myths. It’s a little outdated, but still worth listening to. Google “The Heart of the Matter” +cbc.ca +podcast. It’s in three parts. A long but EXCELLENT listen.

  • another Kathy
  • January 28, 2013
  • 4:53 pm

I am also a RD. After being an AND member for over a decade, I left in 2010 entirely due to their refusal to break ties with Big Food. I had written many emails to AND at many levels with the same response given by their President.

While I personally may or may not believe that AND formulates its positions independent of their Big Food Sponsors, it is irrelevant. I KNOW that a large percentage of the general public (already leery of RDs and suspicious we are just a mouth-piece for the USDA) doesn’t trust any group who says one thing (e.g., limit your intake of sugar sweetened beverages), while getting money (regardless of how little) from conflicting interests (e.g, Big Soda).

It is disappointing that AND won’t sever these ties. Maybe if enough RDs leave their organization, or make a big enough stink, they will be forced to reconsider.

  • Jenn
  • January 31, 2013
  • 9:49 am

I’ve talked about finishing my nutrition degree, but I’m concerned about finding work without being an RD. Yet I refuse to jump through hoops to join such a dishonest organization. After years of personal research, and help via the paleosphere, I refuse to be required to spout the organizations health destroying agenda. Talk about a frustrating situation.

  • Jennifer Stimson
  • February 1, 2013
  • 6:44 pm

I am an RD and think the corporate sponsership of AND is disgusting. If we cannot afford to operate without these funds then perhaps we should not have this organization.

  • Theresa
  • February 2, 2013
  • 1:50 pm

If this logic holds true, then I also believe that any doctor, chiropractor, nutritionist, etc. that sells or endorses supplements should also be considered inadequate to recommend nutrition or supplemental advise.

  • Alisa
  • March 9, 2013
  • 12:26 am

I hope it’s clear that a great number of RDs take issue with the AND and that we are not all puppets to them. If the organization was not so connected to the food industry, maybe we wouldn’t have to work so hard to convince the public that we are “nutrition experts.” I believe our credibility as nutrition professionals is completely lacking because of the AND and their mixed messages.
A great organization that has recently launched on Facebook is the Dietitians for Professional Integrity. They are “composed of Registered Dietitians and Registered Dietitians-to-be who do not support the current model of corporate sponsorships held by the Academy of Nutrition and Dietetics (AND). We believe these sponsorships pose a serious conflict of interest for a nutrition organization, and harm our credential and reputation.”
As Marion said, get involved and let your voice be heard!

  • Larry Cleveland RD LD
  • March 3, 2014
  • 10:15 am

Marion, you wrote: “Lethal But Legal is a superb, magnificently written, courageous, and thoroughly compelling exposé of how corporations selling cigarettes, guns, cars, drugs, booze, and food and beverages enrich themselves at the expense of public health.” The food companies are doing the same thing and we are being prostituted by being patsies in their death march. Simple and straight. The simple fact is our association with these companies, no matter the circumstance arugment, is eroding our reputation. I’m embarrassed buy it. We should be. There is no stand for real health and for what works from production to the table. There is no national stand that the notion a company can make whatever it wants, spend millions on marketing then turn around and pretend to be doing good because they are “trying,” makes us look like the patsies that MD’s are to the drug companies. Look what Medicare did! Strong assertion? What we are doing is failing misurably. I have had it with being up against junk food companies with million dollar ad budgets, scientists figuring out how to hook the brain with chemicals, and Phychologists hammering out what with make a life long customer of the children that are part of a giant failed experiment. Wake up. Out so call food system is breasting the worst sickness care system among industrialized nations in the world, well second to the worst. We care nothing about responsibility but only profit. It’s one thing to be a person in the one percent but to be there and malnourished with heart disease from all the sugar salt and fat that’s killed more people than all the wars, murders and accidents, but to be indifferent and protective about is disturbing. A growing number of us are waking up but we need a food policy with some meat in it, no pun intended.

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