Food Politics

by Marion Nestle
Apr 21 2014

No nutrition in medical education? An old story that might be changing.

JAMA Internal Medicine invited me to comment on an article about the lack of nutrition education in medical schools.  This was written by Nathanial Morris, a second-year medical student at Harvard, who complains about the paucity of nutrition instruction in his curriculum.

Yet the course spanned just 3 afternoons, for a total of 9 hours of instruction…The course directors told us it would be the only time for dedicated nutrition education during our 4 years as medical students. There were no examinations nor interactions with patients. The 1 lecture on obesity lasted 45 minutes…As a medical student, I cannot fathom why medical schools continue to neglect nutrition education.

When I read his article, I didn’t know whether to laugh or cry.  I wrote almost identical articles in the 1980s based on my experience at UCSF (here’s one).

I asked a former UCSF colleague, Dr. Robert Baron, to co-author the commentary with me: Nutrition in Medical Education:  From Counting Hours to Measuring Competence.

Our interest in this issue started nearly 40 years ago, when we were both at the University of California, San Francisco (UCSF), School of Medicine. In 1976, one of us (R.B.B.) was, like Mr Morris, a medical student advocating for nutrition instruction, while the other (M.N.) was a lecturer newly recruited to provide that instruction. For the next decade, we worked together to create “NutritionUCSF,” a comprehensive program of nutrition training that at its peak encompassed 16 hours of preclinical instruction; regular lectures and ward rounds in several clinical rotations; an intensive, 1-month fourth-year clinical elective; an ongoing lecture series for the health professions community; and postgraduate continuing education courses.

In addition to our youthful interest and enthusiasm, we were able to achieve all this for a simple reason: we had funding. Funding came first from a curriculum development grant from the Health Resources Administration and later from a private foundation. These grants allowed us to pay faculty for a small portion of their time and leverage nutrition hours into the curriculum.

Our article explains how at UCSF and some other institutions, nutrition instruction is becoming integrated into overall reform of medical education:

Today’s medical education reform movement must respond to this call by including a broad competency-based approach to improving the nutrition-related skills of physicians. When it does, we may finally have the opportunity to include advice about healthful eating as a routine part of 21st century medical practice.

Some help from Congress?

It is interesting in this context that various members of Congress are introducing bills to improve nutrition education for medical professionals, for example, the EAT for Health Act and the ENRICH Act.  Thanks to Jamie Berger for alerting me to this legislation and for sending some fact sheets about the bills: EAT for Health / ENRICH.

It’s been nearly 40 years since my involvement in this issue.  Ever optimistic, I’m happy to see some progress at last.

And this just in.

The current issue of the American Journal of Clinical Nutrition has papers from a symposium on nutrition in medical education.  The first was in 1962, so the half-century saga continues.

  • Title page, program participants, and TOC:  Am J Clin Nutr 2014;99 1145S-1149S
  • Introduction to Nutrition Education in Training Medical and Other Health Care Professionals. Penny M Kris-Etherton, Charlotte A Pratt, Edward Saltzman, and Linda Van Horn. Am J Clin Nutr 2014;99 1151S-1152S
  • The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Penny M Kris-Etherton, Sharon R Akabas, Connie W Bales, Bruce Bistrian, Lynne Braun, Marilyn S Edwards, Celia Laur, Carine M Lenders, Matthew D Levy, Carole A Palmer, Charlotte A Pratt, Sumantra Ray, Cheryl L Rock, Edward Saltzman, Douglas L Seidner, and Linda Van Horn. Am J Clin Nutr 2014;99 1153S-1166S
  • Nutrition education in medical school: a time of opportunity. Robert F Kushner, Linda Van Horn, Cheryl L Rock, Marilyn S Edwards, Connie W Bales, Martin Kohlmeier, and Sharon R Akabas. Am J Clin Nutr 2014;99 1167S-1173S
  • Residency and specialties training in nutrition: a call for action. Carine M Lenders, Darwin D Deen, Bruce Bistrian, Marilyn S Edwards, Douglas L Seidner, M Molly McMahon, Martin Kohlmeier, and Nancy F Krebs. Am J Clin Nutr 2014;99 1174S-1183S 
  • Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Rose Ann DiMaria-Ghalili, Jay M Mirtallo, Brian W Tobin, Lisa Hark, Linda Van Horn, and Carole A Palmer. Am J Clin Nutr 2014;99 1184S-1193S
  • Policy approach to nutrition and physical activity education in health care professional training. Matthew D Levy, Lisel Loy, and Laura Y Zatz.  Am J Clin Nutr 2014;99 1194S-1201S.
Apr 18 2014

CDC’s food safety report card: no happy news

The CDC has just issued its latest report on foodborne illness and food safety progress from 2006 to 2013.

It’s report has a couple of frowny faces—Campylobacter and Vibrio cases are up—and nothing else has changed.

Nothing to smile about.

Laboratory diagnoses of other foodborne microbial illnesses are also rising.

Figure: Changes in incidence of laboratory-confirmed bacterial infections, United States, 2013 compared with 2006-2008 (data are preliminary). Yersinia = 7% decrease, Vibrio = 32% increase, STEC Non-O157  = 8% increase, STEC O157 = 16% increase, Shigella = 14% decrease, Salmonella = 9% decrease, Listeria = 3% decrease, Campylobacter = 2% increase

The food industry needs to do a better job of producing safe food.

Let’s hope the new food safety rules go into effect soon and get followed.

Apr 17 2014

Is Big Food the new Tobacco?

Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”

Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.

From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.

…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”

… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.

The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food: 

There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.

Sounds like the message is getting across loud and clear.

Thoughts?

Apr 15 2014

Congratulations WashPo: Pulitzer prize for food stamp series

The Washington Post won a couple of Pulitzer Prizes yesterday, among them one for Eli Saslow’s remarkable series on what it’s really like to depend on food stamps. The Post’s understated announcement about this one is because its other prize was for its Snowdon coverage:

The Post’s Eli Saslow also won a Pulitzer — newspaper journalism’s highest award — for a series of stories about the challenges of people living on food stamps. Saslow, 31, was cited in the explanatory-journalism category by the 19-member Pulitzer board in an announcement at Columbia University in New York, which administers the prizes.

If you didn’t get to read the prize-winning articles, here’s your chance.

 

Apr 14 2014

Walmart’s price-cut organics: good, bad, or indifferent?

When Walmart announced last week that it would start carrying Wild Oats organic foods at prices at least 25% below those of national brand organics, I had some conflicted reactions.

Walmart’s rationale sounds terrific:

We know our customers are interested in purchasing organic products and, traditionally, those customers have had to pay more,” said Jack Sinclair, executive vice president of grocery at Walmart U.S. “We are changing that and creating a new price position for organic groceries that increases access. This is part of our ongoing effort to use our scale to deliver quality, affordable groceries to our customers.

But Reuters explains what this is really about:

Organic foods accounted for roughly 4 percent of total U.S. food sales in 2012, but growth in the category for years has outpaced the industry overall, buoyed by growing demand for simpler food made from natural ingredients.

Organic foods often cost more than their conventional rivals, and that has limited purchases by the legions of lower-income U.S. shoppers who are needed to propel a niche product into a national player.

Walmart caters to that audience…”If we can make that price premium disappear, we think it will grow much, much faster,” Jack Sinclair, executive vice president of grocery at Walmart U.S., said of the retailer’s small but faster-growing organic sales.

For Walmart watchers, the announcement raises many concerns.

Tom Philpott, writing in Mother Jones before the recent announcement did a brief investigation of Walmart’s organic and local offerings in Austin, Texas:

Of course, Walmart exists to generate profit, not social change. And that may explain the dearth of produce being trumpeted as local and organic in the Austin store I visited. The city teems with farmers markets, Whole Foods branches, and a successful food co-op. With so many options available, shoppers here are likely not heading to Walmart for their heirloom tomatoes. As Prevor [Jim Prevor, the Perishable Pundit] told me, the company tailors its offerings to each region. It will “essentially sell whatever its customers want, as long as there’s a profit to be made.” 

Forbes asks a tough question: Maybe Walmart has just killed the organic food market?

WalMart getting into organics in a big way [may not be] good news for the industry. Most especially when they say that they’re going to eliminate the price premium that organic has traditionally carried…I don’t think it’s revealing anything terribly new to state that those who preferentially buy organic are often those who would prefer not to be thought of as WalMart shoppers.

And Trillium Asset Management, a company that claims to be devoted to sustainable and responsible investing, wonders whether the Walmart plan means that organics have lost their soul:

Wal-Mart’s pledge…is making a whole lot of people very nervous. Wal-Mart’s modus operandi is to keep prices low by driving down costs in the production chain and keeping its own wages low; its competitors’ practices are variations of the same theme, if less cutthroat. Good ol’ American-style capitalism and its frequent bedfellow, inadequate regulation, now threaten to strip “organic” of everything it once stood for (and everything that has made it more expensive): small scale production, gentler treatment of animals, better treatment of farm workers, and the elimination of chemical aids to production.

My personal observations of Walmart stores also make me skeptical.  I haven’t seen some of the previous promises effectively translated into reality.

Walmart says it will roll out the lower priced organics to about half its 4000 stores by this summer.

I’m reserving judgment until I see how these particular promises are implemented in the stores.

This just in: USDA’s latest data on organic agriculture.

Apr 11 2014

The secret life of food stamps: good for business

The writer Krissy Clark, in a collaboration between Marketplace and SLATE, has produced a remarkable series of articles (with audio and video) on business interests in SNAP, the Supplemental Nutrition Assistance Program formerly known as food stamps.

Here are brief excerpts:

The secret life of a food stamp, April 1

At a private dinner Walmart held for market analysts last fall in Bentonville, Ark., a company vice president estimated Walmart takes in 18 percent of all food stamp spending in the U.S….Meaning, Walmart took in more than $13 billion in revenue, or about 4 percent of Walmart’s total sales in the U.S.

So Walmart is likely the biggest single corporate beneficiary of SNAP, but it’s not just Walmart. A growing number of stores have baked food stamp funding into their business models since the Great Recession. The tally of stores authorized to accept food stamps has more than doubled since the year 2000, from big-box stores like Target and Costco to 7-Elevens and dollar stores. It’s a paradox that the more people are struggling to get by, the more valuable food stamps become for business.

Save money, live better, April 2

Although there are no federal numbers on where employed SNAP participants work, the state of Ohio…does keep a list of the top 50 companies with the most workers and their family members on food stamps. Ohio’s list includes lots of fast food chains and discount and big-box stores: McDonald’s, Target, Kroger supermarket, Dollar General. At the very top is Walmart, which had an average of more than 14,500 workers and family members on food stamps last year. If you take into account the average size of a family on food stamps, as many as 7,000 individual Walmart employees were on food stamps last year—nearly 15 percent of the company’s workforce across Ohio.

That means the same company that brings in the most food stamp dollars in revenue—an estimated $13 billion last year—also likely has the most employees using food stamps.

 Hungry for savings, April 3  

Like many anti-hunger advocates who receive donations from corporate retailers known for low wages, Elchert is in a tricky spot when it comes to addressing the paradoxes of the food stamp economy. His group gets financial support from Walmart and other food retailers. “When we’re talking a lot with corporations,” he says, “it’s one of those situations where, well, let’s talk about this in some way where we’re not offending them.”

I’ve talked about this issue in previous posts.  Here are some additional resources on the issue:

 

Apr 10 2014

The trans fat “ban”: stakeholder politics in action

Food Navigator has a terrific summary of the current fight over the FDA’s proposed “ban” on trans fat.  I put “ban” in quotes because it’s officially a revocation of GRAS (generally recognized as safe) status .

Doing something to get rid of trans fats is a no brainer.

  • Trans fats raise the risk for heart disease
  • No safe level has been defined.
  • Plenty of replacement oils exist.

But, as Food Navigator’s Elaine Watson demonstrates, the battle lines are drawn.  Here is her helpful list of who is on which side of efforts to get trans fats out of the food supply.

Public health groups supporting the FDA’s action

Groups asking for rescinding the ban or leaving loopholes

And for what this is all about

Apr 9 2014

Lobbying against the minimum wage for restaurant workers

Bill Moyers interviewed Saru Jayaraman of the Restaurant Opportunities Center United (ROC United) about the attacks from the Restaurant Industry on this organization’s efforts to raise the minimum wage for tipped workers.  In many states, that wage is  $2.13 an hour.

BILL MOYERS: Welcome. If you wonder why so many Americans doing essential but menial work at low wages never seem to get a break, here’s an answer for you. That’s how it’s intended to be. Not by nature, or the market, or from any lack of character or will on the part of workers. No, the fact is: our system is organized against them. The very thing workers most want and need – a fair wage – is the very thing the controlling interests don’t want them to have. And by controlling interests, I mean the owners of capital, who were emboldened even further this week by the Supreme Court’s McCutcheon decision giving monied interests more opportunity to rig the political system against everyday Americans.

As Jayaraman explains,

we would argue that evidence shows that you could actually do better as an industry, faster industry growth, more jobs, if you treat your workers better…it would cost the average American household at most $0.10 more for all food bought outside the home. That’s groceries and restaurants alike. So we’re talking pennies more on your hamburger when you eat out, for 30 million workers to come out of poverty.

But let’s look at how the political system gets rigged against low-wage restaurant workers.  For this, its useful to check the Open Secrets database on “The Money Against The Minimum Wage.”

The list of organizations that signed a letter opposing the minimum wage increase and how much they spent on total lobbying in 2013.  Three examples:

  • American Hotel and Lodging Association     $1,310,000
  • National Restaurant Association                         $2,238,691
  • US Chamber of Commerce                                  $74,470,000

No, that last one is not a misprint.

Why would the US Chamber of Commerce spend more than $74 million on lobbying?

As the New York Times explains,

The chamber has had little trouble finding American companies eager to enlist it, anonymously, to fight their political battles and pay handsomely for its help.

And these contributions…also show how the chamber has increasingly relied on a relatively small collection of big corporate donors to finance much of its legislative and political agenda.

Who donates to the Chamber of Commerce?  It’s a secret.

The chamber makes no apologies for its policy of not identifying its donors. It has vigorously opposed legislation in Congress that would require groups like it to identify their biggest contributors when they spend money on campaign ads.

This is another reason why it’s so important to support ROC and its campaigns.

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