by Marion Nestle

Currently browsing posts about: Conflicts-of-interest

Oct 29 2009

Family doctors resign from AAFP over Coke partnership

Yesterday, 20 family physicians in Contra Costa County, California, ripped up their membership cards in the American Academy of Family Physicians in protest over the AAFP’s partnership with Coca-Cola.

coke_1

The director of the Contra Costa Department of Health Services, Dr. William Walker, announced that he was resigning his 25-year membership in AAFP.  In his statement, Dr. Walker said:

…I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death.

…The AAFP is supposed to be an organization that works to protect the health of children not put them at risk. Their decision to take soda money is all the more unconscionable because, unlike doctors in the 40s, they well know the negative health impact of soda. There is no shortage of documentation that soda is a major contributor to our nation’s obesity epidemic.

…Let me be clear about something: as disappointed as I am with the American Academy of Family Physicians for being duped into thinking that Coca Cola wants to help promote health, the real problem here is our children are being put at risk.

Companies like Coca Cola are polluting our communities with deceptive advertising promoting products that put our children’s health at risk.

…as a family practice doctor and the Health Officer for Contra Costa, I do have a prescription for every parent, teacher, community leader and student:

Look beyond the glitzy advertising that makes you think pouring liquid containing sugar into your body is healthy. Read the label. Look at the ingredients. I’m not suggesting that you boycott sugared drinks, but please make an informed decision about what you are consuming.

I’m calling on every city and neighborhood in our County to fight back against the industry that pushes these harmful products. I ask the American Academy of Family Physicians to end this unhealthy partnership and to join us in leading this important campaign to take back the health of our residents and end the obesity epidemic.

Strong words, indeed.  I hope that the AAFP – and other health and nutrition organizations that might consider food industry partnerships – pay close attention to these words.

* The event was covered in the Contra Costa Times. The Health Department’s website includes the press release and also a video and podcast.

Addendum:

Dr. Wendel Brunner, PhD, MD, Director of Public Health in the Contra Costa Department of Health Services has given me permission to post excerpts from his letter to a representative of the California Association of Family Physicians who had asked for more information about the protest:

“The epidemic of obesity is the greatest public health and clinical medicine issue of our time, and will lead to untold disease, shortened life spans, and medical cost. That epidemic took off rapidly in the 80’s. While genes and personal choices do have an impact on obesity, only profound environmental changes could lead to such a rapid development of the epidemic, and it will only be stopped by policy development and environmental and norm change. We need to create an environment that supports people in making good choices for themselves and their families.

One of the best choices families can make is to pretty much eliminate sweetened beverages. And the soda industry doesn’t want that to happen, so they are looking for credible groups who will say that drinking soda is OK for your health. But you know all that already, which makes this even more frustrating.

I am an old county doctor, but I still believe that physicians have a responsibility to advocate for their patients and fight to protect their health, and to first of all, do no harm. I am truly gratified to see that our younger physicians in Contra Costa have those same values too. The responsibility of a physician to their patient is a sacred trust; physicians should never sell out their patients’ health and well-being for a price, not even one “in the mid six figures”.

The AAFP needs to change their policy and thereby begin to redeem themselves. In the process, they would educate the country and do something valuable for the nations health, as well as for their own integrity. If they do not, they will continue an unfortunately long and sordid tradition of professionals and their organizations forgetting their purpose and their ethics and putting their narrow organizational financial interest above the interest of the public that they serve. Resigning membership seems to be the most effective way for physicians to provide a wake-up call to the AAFP, and at this point is the best thing a physician could do to benefit the organization.We anticipate that there will be more resignations as this story develops.

Everything cannot be blamed on the environment or peer pressures or economic factors; patients do have a personal responsibility to make good choices for their health and the health of their families. But physicians have the personal responsibility to make good choices too, and so do the professionals who work for them.

The AAFP and the individuals in it made a bad choice. They now have the responsibility to fix it.”

Oct 12 2009

San Francisco Chronicle column

For my latest San Francisco Chronicle column, I borrowed a query from a reader of this blog demanding financial disclosure.  This gave me the opportunity to discuss how sources of funding – especially from food companies – raise questions about whom to trust when it comes to nutrition advice.  Thanks to all of you who commented on that original post.  Most interesting.

The column appears in the Food and Wine section.  Although the San Francisco Chronicle, like many newspapers, is ailing badly, this section has just been selected by the Association of Food Journalists to win its award for best section.  I’m proud to be part of it.

Sep 26 2009

The Not-So-Smart Choices story continues…

We now have a piece mentioning the Smart Choices program in The Economist as well as a letter from Dr. Eileen Kennedy, the member of the Smart Choices program committee to whom the quotation about Froot Loops, “Better than a doughnut,” is attributed.

The Economist discusses the booming business of functional foods: “Consumers are swallowing such products, and the marketing claims that come with them.” It mentions the fuss over Smart Choices, but the best part is the caption to the illustration that comes with it.

It's practically spinach

It's practically spinach

And, I’ve been sent a copy of an e-mail letter to alumni from Dr. Eileen Kennedy, dean of the Friedman School of Nutrition Science and Policy at Tufts University, explaining her participation in the Smart Choices program:

Dear Friedman School Alumni,

There is an issue that has emerged as a result of a NY Times article that appeared in the business section on Sept 5, 2009. Since I believe I was grossly misquoted in the article and that the article does not accurately depict the Smart Choices program, I want to share with you some background on this program and my involvement.

In 2007, I was invited to join the Keystone Roundtable on Food and Nutrition. Keystone is a non-profit organization that brings individuals together around potentially controversial issues. The roundtable included health organizations, food companies, retailers, and academic researchers from a variety of U.S. universities. I was one of the academics who served pro bono on the roundtable. Initially, we met to discuss revisions to the FDA nutrition label. Ultimately, we decided to address the issue of Front of Pack Labels on food products. The final recommendations of the group were based on consensus science including the Dietary Guidelines for Americans, the FDA definition of healthy, WHO recommendations and the Institute of Medicine Scientific reports. The program that emerged from this meticulous process is called “The Smart Choices Program (SCP).” Food products that qualify as “better for you” get a check mark as well as disclosure of calories per serving and number of servings in a product.

I believe there are three major advantages to this program in addition to the rigorous scientific underpinnings.

First, the SCP is intended to improve food patterns at point of purchase – the super markets. To do this, food products are divided into 19 categories – based on research – that reflect how people buy food. All fruits and vegetables without additives automatically qualify.

Second – and a major plus – the program was tested prior to launch with consumers.

Finally, food companies who participate in the program have agreed to abandon their proprietary systems and adopt one system – the Smart Choices Program.

Thus, thousands of products using the SCP check mark will reach millions of consumers. It is a credit to the social responsibility of participating companies that because of the strict nutrition criteria, fewer of the individual food products will qualify for the Smart Choices Program.

As a non-industry board member, I have been targeted by negative emails, letters and even some phone calls. I regret that some of this hostility has been focused on the Friedman School and Tufts University and must note that I serve as an individual on the Smart Choices Program. Tufts University is not involved with it….

As nutritionists, we know that, in many ways, the science of nutrition is straight-forward. It is the translation of science into action that is often complex and can be contentious. Within our field, there are many opinions on how to improve the nutritional well-being of people worldwide. It is precisely at an academic institution like Tufts that we should have a respectful and open dialogue about these issues….For additional information, you may also want to go to www.smartchoicesprogram.com….

The letter gives me a chance to repeat a few points that I have made in previous posts (see Smart Choices, Scoring Systems) and on the general matter of corporate sponsorship of nutrition activities (tagged as Sponsorship).

First, this enterprise was paid for by participating companies to the tune of $50,000 each for a total of $1.67 million.  Social responsibility?  I don’t think so.  Companies usually get what they pay for.  Hence: Froot Loops.

Second, a comment on the research basis.  I have written extensively in Food Politics and in What to Eat about the influence of food companies on federal dietary guidelines and the compromises that result.  Even at its best, the process has to be impressionistic and cannot be either meticulous or rigorous.  The guidelines are meant to be generic advice for healthful eating.  They were never meant to be used – and cannot be used – as criteria for ranking processed foods as healthful.

The FDA standards for comparison to Daily Values on food labels are also worth a comment.  They were the basis of Hannaford supermarkets’ Guiding Stars program, which awards one, two, or three stars to foods that meet FDA-based criteria.  By those criteria, Froot Loops does not qualify for even one star.  If Smart Choices had relied on FDA criteria, such products would not be check marked.

Dr. Kennedy makes some excellent points in her letter and I particularly agree with one of them: nutritionists differ in opinion about how best to advise the public about diet and health.  Mine is that the Smart Choices program is a travesty and the sooner it disappears, the better.

September 29 update: The L.A. Times weighs in with a story (which quotes me).  It’s got another great comparison from a member of the Smart Choices committee:  “Cereal provides an array of nutrients and is a good breakfast…especially if the alternative is a sweet roll.”  My son, who saw the story, has this comment: “Hey! I think Froot Loops are a “Smart Choice.” After all, they have “froot,” don’t they? And maybe no nutritionist you know would recommend Froot Loops for breakfast, but what about for lunch or dinner?”

Sep 19 2009

Request for financial disclosure

Someone whom I do not know, Zhiqi Yin, sent this message to this site in two places today:

I saw this on Twitter. “I am so sick of food Nazis like Marion Nestle who makes lots of money criticizing others. Marion, disclose who is paying you and $ you make.”  Kindly tell your audience when can we expect to see your financial disclosure telling us how much you make from writing books critical of the food industry, money you receive from speaking and other engagements, and grant and consulting money and your sources? Thank you.

Despite its unfriendly tone, the question is an important one in an era when opinion is so easily bought and sold, and evidence so increasingly demonstrates the influence of corporate funding on the outcome of tobacco, drug, and food research.

The purpose of food company influence is of course to increase sales and profits. In contrast, the goals of public health are to improve dietary intake and other health behaviors so that people will live longer and more active and productive lives.  Those of us devoted to public health, however, often find that our goals conflict with those of sales and profit.

As I explained in my book, Food Politics, I am in an unusual position for an academic researcher and I take the resp0nsibility that comes with this position quite seriously.  I am a tenured professor at New York University, a job that requires teaching, research, and public service (of which this blog is part).  For doing these things, I receive a full, hard-money salary that allows me to remain independent of corporate influence and gives me the freedom to write and speak as I think.   I do not need grants to do my research and writing.  I accept honoraria from some speaking engagements (these take substantial preparation and travel time), compensation for some writing assignments (ditto), and occasional royalties from sales of my books (which take years to research and write).  To fulfill my professorial obligations, I do not need to consult for pay or accept honoraria from food companies or other for-profit enterprises.

I wish that my books were best sellers.  I wish everyone would read them and think hard about what they say.   And I wish that more nutrition academics and professionals could be independent of corporate influence.

I am able to take full responsibility for what I think, say, and write.  I am paid to say what I think, not what someone else wants me to think or because what I write or say will help sell food products.   This is indeed a privilege and I am grateful for it.

May 18 2009

Reply from the American Society of Nutrition

Last week, I posted correspondence regarding the American Society of Nutrition’s (ASN) partnership with the industry-sponsored Smart Choices program.  This program places a check mark on food products that meet its nutrient standards.  I am concerned about ASN’s involvement in this project as it puts the society in conflict of interest.  Several other food rating systems are under development, among them the traffic-light system used in Great Britain.  How can the ASN objectively evaluate the relative merits of these systems if it is paid for administering – and, therefore, endorsing – Smart Choices?  I much prefer the traffic light system, have concerns about the entire approach, and think some of the standards overly generous, particularly the upper limits of 25% of calories from added sugars and 480 mg sodium per serving.  Several people who commented on my post asked to see the ASN’s response.  Here it is:

From: John E. Courtney, Ph.D., Executive Officer, American Society of Nutrition
Sent: Tuesday, May 12, 2009 10:24 AM
Subject: Sunday, May 10, 2009 10:36 AM email to Katrina Dunn

Importance: High

Dear Dr. Nestle,

Thank you for your comments on ASN and the Smart Choices program. We value feedback from our members and I’d like to take this opportunity to address some of your concerns and amend a few of the points you made. First, The Smart Choices Program is not an industry-initiated plan. The Smart Choices idea was facilitated by the Keystone Center, which works with a broad array of stakeholders to develop solutions to complex health and social problems. The Smart Choices front-of-pack symbol was developed through a series of plenary meetings over two years and intensive work groups with academics, food manufacturers, public health organizations, and with observers from federal agencies.  This unique process with a broad array of stakeholders along with the fact that the program is completely transparent sets it apart from other programs that have been developed. In the fall of 2008, Keystone Center issued a RFP for organizations interested in administering the program. The ASN Executive Board was briefed on the program, discussed and evaluated it, and approved moving forward. ASN partnered with NSF to administer the program and was selected. ASN’s role will primarily be one of oversight and facilitation of the program governance, and the Society will be responsible for maintaining the scientific integrity in the Smart Choices program. This program was discussed at the ASN Volunteer Member Leadership Summit in January and most recently at the ASN Scientific Sessions and Annual Meeting at Experimental Biology in New Orleans, LA in April, 2009.

Perhaps most exciting for the Society and consistent with its mission is that ASN will be coordinating a rigorous evaluation of the program as well as consumer research to determine the effectiveness of the program. Perhaps most importantly, ASN neither “owns” the program nor are we making any profit from the program. The funds generated from company participants will be reinvested into the program.  ASN is the pre-eminent society for nutrition researchers and practitioners and encourages scientific debate and transparency and is looking forward to evaluating the effectiveness of this program in helping consumers.

Thank you again for your comments and for your commitment to advancing nutrition research and practice.



May 11 2009

Open letter to nutrition colleagues

Over the weekend, I received a letter from the American Society of Nutrition (ASN) nominating me to join the Board of Directors of the Smart Choices program.  Smart Choices, you may recall from my previous posts on this program as well as on other such systems, is a food industry-initiated plan to put a check mark – a stamp of approval – on processed food products that meet certain nutritional criteria.  Apparently, the ASN Board agreed to administer (and, implicitly, endorse) this program without discussing the matter with the membership.  I think involvement of independent nutrition researchers with Smart Choices represents a conflict of interest and the ASN should not be involved in this effort.  Here is what I told Katrina Dunn, the ASN Program Coordinator:

Dear Katrina—

Thank you for inviting me to join the Board of Directors of the Smart Choices program.  I regret that I cannot accept.  Participating in Smart Choices represents a serious conflict of interest for nutrition educators who wish to maintain independence from the influence of the food industry on nutrition advice.

But participation also represents a serious conflict of interest for the American Society of Nutrition (ASN).  I am dismayed that the ASN—an organization devoted to the highest standards of nutrition research–is involved in this project.  I think the ASN should reconsider this involvement and withdraw immediately.

The ostensible purpose of Smart Choices is to guide the public to select more healthful foods.  I am unaware of a research basis indicating that the program is likely to succeed in this goal.

Evidence does, however, support two additional goals of the program.  The first is to provide a basis for marketing highly processed food products.  I think we would all agree that highly processed foods are, in general, demonstrably nutritionally inferior to whole or minimally processed foods.

The second is to stave off federal regulations requiring a traffic-light food rating system such as that in use in the United Kingdom.   Preliminary research indicates that consumers prefer this system to numerical scores and understand the colors to mean that they should choose green-lighted foods and avoid red-lighted foods.

The cut points selected for the Smart Choices program may meet criteria of the Dietary Guidelines, but their health benefits are debatable (the sodium cut point is particularly generous).  Surely, a great deal more research is needed before ASN directly or indirectly endorses specific processed foods simply because they meet arbitrary nutrient cut points.

These concerns all address questions of intellectual conflict of interest.  But I am also concerned about financial conflicts of interest.  If ASN receives payment for its endorsement and administration of this program, the organization—and its members—risk losing intellectual independence.

I appreciate the invitation but I believe the entire program is ill advised and I urge ASN to extricate as quickly as possible.

Sincerely yours,

Marion Nestle
Paulette Goddard Professor of Nutrition, Food Studies, and Public Health
New York University

Apr 22 2009

Food industry self-monitoring

If it’s one thing the food industry does really well, it’s surely to pat itself on the back.  Something called The Ethisphere Institute (motto: “Good.  Smart.  Business. Profit.”) has produced a list of the world’s most ethical companies, among them Kellogg’s, Danone, PepsiCo, and Unilever.  How did Ethisphere do this?  It analyzed data from the companies.  I’m guessing it didn’t include marketing to children or misleading health claims as ethical criteria.

And food company representatives have gotten together to establish guidelines for funding food and nutrition research so as to prevent conflicts of interest.  The guidelines make sense – keep everything transparent and stay out of the way of research and publication – but do not address what I see as the most serious consequence of food industry sponsorship: setting up research studies to  inevitably yield results that favor the sponsor’s products.

This, I can assure you, is remarkably easy to do and happens all the time (see, for example, my post on Açaí).

Yes, food and nutrition research is difficult to do and interpret.  That is why independent funding is essential.  At least that’s how I see it.  You?

Apr 10 2009

Is free-range pork more contaminated than industrial pork?

My e-mail inbox is flooded with copies of an op-ed from today’s New York Times arguing that pigs running around outside have “higher rates” of Salmonella, toxoplasma, and, most alarming, trichina than pigs raised in factory farms. The writer,  James McWilliams, is a prize-winning historian at Texas State San Marcos whose forthcoming book is about the dangers of the locavore movement to the future of food.

I put “higher rates” in quotation marks because that is not what the study measured.  The study on which McWilliams based his op-ed is published in Foodborne Pathogens and Disease. The investigators actually measured “seropositivity” (antibodies) in the pigs’ blood.  But the presence of antibodies does not necessarily mean that the animals – or their meat – are infected.  It means that the free-range pigs were exposed to the organisms at some point and developed immunity to them.  The industrial pigs were not exposed and did not develop immunity to these microorganisms.  But you would never know that from reading the op-ed.   How come?

Guess who paid for the study?  The National Pork Board, of course.

The Center for a Livable Future at Johns Hopkins has much to say about all this.  My point, as always, is that sponsored studies are invariably designed in ways that produce results favorable to the sponsor.    In this case, the sponsor represents industrial pork producers.

April 14 update:  the editors of the New York Times have added a note to the electronic version of Professor McWilliams’ op-ed pointing out the National Pork Board sponsorship of the study on which he based his piece.  And McWilliams rebuts arguments against his piece on the Atlantic Food Channel, while conceding that he may have gotten the science wrong.

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