by Marion Nestle

Search results: global energy balance

Aug 13 2015

The Guardian: Coca-Cola says its drinks don’t cause obesity. Science says otherwise

I wrote this piece for The Guardian in response to the New York Times article earlier this week about Coca-Cola’s funding of scientists who think obesity is more about exercise than drinking sodas:

These days, you almost have to feel sorry for soda companies. Sales of sugar-sweetened and diet drinks have been falling for a decade in the United States, and a new Gallup Poll says 60% of Americans are trying to avoid drinking soda. In attempts to reverse these trends and deflect concerns about the health effects of sugary drinks, the soda industry invokes elements of the tobacco industry’s classic playbook: cast doubt on the science, discredit critics, invoke nanny statism and attribute obesity to personal irresponsibility.

Casting doubt on the science is especially important to soda makers. Overwhelming evidence links habitual consumption of sugary drinks to poor health. So many studies have identified sodas as key contributors to chronic health conditions – most notably obesity, type-2 diabetes and coronary artery disease – that the first thing anyone trying to stay healthy should do is to stop drinking them.

Soda companies know this. For at least the last 10 years, Coca-Cola’s annual reports to the US Securities and Exchange Commission have listed obesity and its health consequences as the single greatest threat to the company profits. The industry counters this threat with intensive marketing, lobbying and millions of dollars poured into fighting campaigns to tax or cap the size of sugary drinks.

But it is also pours millions into convincing researchers and health professionals to view sodas as benign.

Just last month, the Mayo Clinic Proceedings published a study arguing that the results of national dietary surveys, such as those that link sugary drinks to type-2 diabetes, are so flawed that they constitute a major misuse of public funds. The authors report honoraria, speaking and consulting fees from Coca-Cola.

This week’s revelation of Coca-Cola’s funding of the Global Energy Balance Network is only the latest example of this strategy in action. The Network promotes the idea that to prevent obesity you don’t need to bother about eating less or drinking less soda. You just have to be more active. Never mind that most people can’t lose weight without also reducing their intake.

A reporter who looked into this group discovered that Coca-Cola had funded the research of the scientists behind it, and generously. The network’s website was registered to Coca-Cola. None of this, however, had been made explicit.

Most nutrition professional journals now require researchers to declare who funds their studies, making it possible to compare study outcomes with funding sources. Studies sponsored by Coca-Cola almost invariably report no association of sugary drinks with diabetes, they question the validity of studies that do find such associations or, as in the case of Global Energy Balance Network investigators, they find activity to be the most important determinant of body weight.

Analyses of studies funded by Coca-Cola or its trade association demonstrate that they have an 83% probability of producing results suggesting no harm from soda consumption. In contrast, the same percentage of studies funded by government agencies or independent foundations find clear linkages between sugary beverages and such conditions. Coincidence? I don’t think so.

Since March, I’ve been posting industry-funded studies with results that favor the sponsor’s interests every time I find five of them. They are easy to find. Despite pleas to readers to send me industry-funded studies that do not favor the sponsor, I hardly ever get them. Whenever I come across a study that shows no harm from sodas, I immediately look to see who paid for it.

Soda companies spend generously to convince researchers and health professionals not to worry about sodas’ health effects. But why do researchers take the money? It is too simplistic to say that they are “bought.” Industry-funded investigators say they believe the funding has no effect on the design, conduct or interpretation of their research. But research involves choices of questions, assumptions and methods. It is not difficult to carry out a study that appears to meet high scientific standards yet fails to include critical controls that might lead to alternative conclusions.

Researchers funded by Coca-Cola need to take special care to control for unconscious biases but can only do this if they recognize the possibility. Many do not. Neither do many peer reviewers or editors of scientific journals. Although food-company financial support should not necessarily bias results, it appears to do so in practice.

Industry-funded scientists resent questioning of the influence of sponsorship on the quality of their science. They charge that investigators who find adverse effects of sodas on health are equally biased by career goals, righteous zeal or anti-corporate morality. Yes, independent scientists may have biases of their own, but their overarching research goal is to improve public health. In contrast, the goal of soda companies is to use research as a marketing tool.

Disclosure is essential. If a study is funded by Coca-Cola, caveat emptor.

Aug 12 2015

Coca-Cola’s promotion of activity: a follow up

I’ve had a busy week dealing with the aftermath of Anahad O’Connor’s New York Times story about how Coca-Cola pays scientists who argue that obesity is more about activity than what you eat—drinking sodas, for example (I’m quoted).   It’s gotten 1180 comments.

Here’s Dan Wasserman’s from the Boston Globe:

In all fairness, let’s see what Coca-Cola’s Chief Technical Officer, Dr. Ed Hays, says in response (straight out of the tobacco industry’s playbook):

I was dismayed to read the recent New York Times’ inaccurate portrayal of our company and our support of the Global Energy Balance Network (GEBN). The story claimed Coke is funding scientific research to convince people that diets don’t matter – only exercise. In fact, that is the complete opposite of our approach to business and well-being and nothing could be further from the truth.

Yes, we fund scientific research through GEBN and we are proud to support the work that scientists such as Dr. Jim Hill and Dr. Steve Blair do – because their type of research is critical to finding solutions to the global obesity crisis.

At Coke, we believe that a balanced diet and regular exercise are two key ingredients for a healthy lifestyle and that is reflected in both our long-term and short-term business actions.

The article even got the attention of Congress.  Here’s the statement from Rosa de Lauro (Dem-CT), sponsor of The SWEET Act to tax sugars:

This research is reminiscent of the research conducted by the tobacco companies to mislead the public about the health risks of smoking.  The American public will not be fooled. There is a wealth of sound scientific research that demonstrates the link between sugar-sweetened beverage consumption and a host of health conditions, including diabetes, heart disease, and obesity.  This new group and their research are a sham,” DeLauro said.  “People want to be healthy and they want their kids to be healthy and realize that drinks full of empty calories are not good for them. That is why more and more Americans are opting to drink less soda every year.

I wrote a piece for The Guardian, which I will post tomorrow.

I don’t keep track of my interviews or media appearances unless people send me links (I post them under Media), but Rachel Harrison at NYU kept score yesterday.  As I said, a busy couple of days.

Additions, August 14

Fox News, August 11

  • Shepard Smith says “the story “reminds you of exactly what the tobacco industry did back in day, and more recently, it also reminds you of what the climate deniers — the climate change deniers — are doing as well.”
  • Rush Limbaugh said the Times‘ Coca-Cola story “undermine[s] the whole notion of a scientific consensus,” because it “can be bought and paid for.”

New York Times editorial, August 14

the evidence continues to mount that sugar-sweetened drinks are a major contributor to obesity, heart disease and diabetes, and that exercise makes only a modest contribution to weight loss compared to ingesting fewer calories.

Jul 21 2023

Why ultra-processed foods matter: the state of world hunger

The Food and Agriculture Organization of the U.N. released its annual State of Food Security and Nutrition in the World report last week.  Its conclusions are sobering.

Global hunger is still far above pre-pandemic levels. It is estimated that between 690 and 783 million people in the world faced hunger in 2022. This is 122 million more people than before the COVID-19 pandemic. Nonetheless, the increase in global hunger observed in the last two years has stalled and, in 2022, there were about 3.8 million fewer people suffering from hunger than in 2021. The economic recovery from the pandemic has contributed to this, but there is no doubt that the modest progress has been undermined by rising food and energy prices magnified by the war inUkraine. There is no room for complacency, though, as hunger is still on the rise throughout Africa, Western Asia and the Caribbean.

Ultra-processed foods are a critical part of this story.  The word “processed” comes up 264 times in this report; “highly processed” comes up 99 times .  Some examples:

  • Healthy diets are essential for achieving food security goals and improving nutritional outcomes. A healthy diet…is based on a wide range of unprocessed or minimally processed foods, balanced across food groups, while it restricts the consumption of highly processed foods and drink products…Eating a healthy diet throughout the life cycle is critical for preventing all forms of malnutrition, including child stunting and wasting, micronutrient deficiencies and overweight or obesity. It also helps reduce the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes and certain types of cancer.
  • The unfinished agendas to reduce stunting, wasting and micronutrient deficiency, along with rising overweight and obesity, represent the current challenge to address multiple forms of malnutrition. Malnutrition in all its forms is related to poor diets, the rise of low-cost
    nutrient-poor foods and the increasing availability of highly processed foods in rural areas.
  • Supply-side factors, including globalized technology in food production, transportation and marketing, coupled with an increase in demand for readily available foods, have contributed to a substantial expansion of supermarkets, hypermarkets, food deliveries and other convenience retailers. However, these are also associated with increased supply and spread of energy-dense and highly processed foods.
  • However, urbanization has also contributed to the spread and consumption of processed and highly processed foods, which are increasingly cheap, readily available and marketed, with private sector small and medium enterprises (SMEs) and larger companies often setting the nutrition landscape. Cost comparisons of individual food items and/or food groups from existing studies indicate that the cost of nutritious foods – such as fruits, vegetables and animal source foods – is typically higher than the cost of energy-dense foods high in fats, sugars and/or salt, and of staple foods, oils and sugars.
  • The dynamics of supply and demand for processed foods, however, are complex. There has been a surge on the supply side, with small and medium enterprises and large private companies alike making massive aggregate investments in all types of processed foods (from minimally to highly processed) in response to demand. At the same time, aggressive marketing and relatively low pricing – and even interference in policies to curb consumption of highly processed foods and sugar-sweetened beverages – are driving up consumption.

The report emphasizes the importance of food processing in contributing to poor diets and health.

What is to be done?  From the Brief summary:

Leveraging connectivity across the rural–urban continuum will require adequate governance mechanisms and institutions to coordinate coherent investment beyond sectoral and administrative boundaries. To this end, subnational governments can play a key role in designing and implementing policies beyond the traditional top-down approach. Approaches to agrifood systems governance should ensure policy coherence among local, regional and national settings through the engagement of relevant agrifood systems stakeholders at all levels.

I read this as saying what’s need is community-based, bottom up approaches at the local level.  That’s a great place to start.  Go for it.

Resources

 

Jul 12 2018

Food Navigator’s collection of articles on “healthy fats”

Fat remains in the news.  Which ones are health, and which not?  FoodNavigator-USA collects its articles on the topic.  My thoughts:  Beyond that, food fats are mixtures of monounsaturated, polyunsaturated, and saturated fatty acids, of the omega-3, -6, and -9 varieties.  And then there are the hydrogenated trans-fats.  These variations make fats complicated.

One attribute of fats is not complicated: fat has 9 calories/gram compared to 4 for protein and carbohydrate.  A tablespoon of oil, butter, lard, or tallow has about 100 calories.  If you are concerned about energy balance, watch out for fat calories (and the other ones count too).

FoodNavigator’s Special Edition: Healthy fats
Fat – we are told – is back. But what kind of fat, and can you have too much of a good thing? Is the science changing on saturated fats? Is whole milk a better choice, or should we stick to low fat dairy? Is coconut oil as healthy as some marketers make out, and is the pressure off to reduce fat now all eyes are on added sugar?  Get the lowdown on fat in this special edition…

Dec 1 2015

Five more sponsored studies with expected results. The score: 80:6

In case you haven’t been following this saga, I’ve been collecting studies funded by food companies since last March and posting them according to whether the results do or do not favor the sponsor’s interests.  So far, I’ve reported 80 that do, versus 6 that don’t (although I have a couple more saved up for posting soon).

The point of this exercise is to demonstrate that sponsored studies are far more likely to favor the interests of the sponsor than are studies funded by government agencies or foundations, and to argue for more independent funding of food and nutrition research (see my recent Viewpoint on this topic in JAMA Internal Medicine).

Here are five more examples.

Is consuming yoghurt associated with weight management outcomes? Results from a systematic review. J Eales, I Lenoir-Wijnkoop, S King, H Wood, F J Kok, R Shamir, A Prentice, M Edwards, J Glanville, R L Atkinson. Int’l J Obesity 2015 ahead of print.

  • Conclusions: Yoghurt consumption is associated with lower BMI, lower body weight/weight gain, smaller waist circumference and lower body fat in epidemiological studies. RCTs [randomized controlled trials] suggest weight reduction effects, but do not permit determination of a cause/effect relationship. Well-controlled, adequately powered trials in research and community settings appear likely to identify a modest but beneficial effect of yoghurt consumption for prevention of weight gain and management of obesity. The ready availability of yoghurt (a nutrient dense food) and its ease of introduction to most diets, suggests that educating the public to eat yoghurt as part of a balanced and healthy diet may potentially contribute to improved public health.
  • Funding: This project was funded by Danone Institute International.
  • Conflict of interest statement: York Health Economics Consortium received funding from Danone Institute International to conduct this review. York Health Economics Consortium has received funding from the Global Alliance for Probiotics, Danone and the European Food Safety Agency for projects involving food and health topics. FJK is member of the Scientific Advisory Board Global Dairy Platform, Chicago USA RS is President of Danone Institute International ILW is employed by the Danone Company, France.

Red Meat and Colorectal Cancer: A Quantitative Update on the State of the Epidemiologic ScienceDominik D. Alexander PhD, MSPHab*, Douglas L. Weed MD, PhDc, Paula E. Miller MPHb & Muhima A. Mohamed M PHd. J Am College Nutrition 2015;34: 521-43.  DOI:10.1080/07315724.2014.992553

  • Conclusion:  The state of the epidemiologic science on red meat consumption and CRC [colorectal cancer] is best described in terms of weak associations, heterogeneity, an inability to disentangle effects from other dietary and lifestyle factors, lack of a clear dose-response effect, and weakening evidence over time.
  • Funding: This manuscript was partially funded by Meat & Livestock Australia (MLA). MLA did not contribute to the writing, analysis, or interpretation of study findings.
  • Comment: The conclusion of this industry-funded study contradicts the findings of the WHO International Agency for Research on Cancer, which finds processed meats to be carcinogenic, and red meat to be a probable carcinogen.

The challenges of nutrition policymaking. Joanne Slavin.  Nutrition Journal (2015) 14:15 DOI 10.1186/s12937-015-0001-8.

  • Thrust of paper: As every DGAC [Dietary Guidelines Advisory Committee] wants to be bold and set new direction, nutrition science would support that first we must do no harm with our dietary guidance. Moderation and variety must be kept front and center…A suggestion that all Americans should reduce sodium intakes is not sound and is potentially dangerous. Targeting certain foods and beverages, including chocolate milk, processed meats, added sugars, and even the noble potato as villains in the nutrition wars is not a science-based strategy and may need to be countered on the political front if appointed scientific review committees continue to take this approach.
  • Competing interests: In the past 5 years Dr. Slavin has received research grants from Minnesota Beef Council, Minnesota Cultivated Wild Rice Council, Novartis Consumer Health, USA Rice, Nestle Nutrition, Tate and Lyle, General Mills, Inc., USA Pears and American Pulse Association. In the past 5 years Dr. Slavin has received speaking fees from food companies and commodity groups with interests in processed foods, dairy products, meat, pulses, fruits, vegetables, fiber, grains, and carbohydrates. Dr. Slavin has participated in scientific panels and advisory boards that are funded by food companies, ingredient companies, commodity groups, scientific societies, and trade groups. She holds a third interest in the Slavin Sisters LLC, a 119-acre farm in Southern Wisconsin.

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies PJ Rogers, PS Hogenkam , C de Graaf, S Higgs, A Lluch, AR Ness, C Penfold, R Perry, P Putz, MR Yeomansand DJ Mela.International Journal of Obesity (2015), 1–14 10 November 2015; doi:10.1038/ijo.2015.177

  • Conclusions: Overall, the balance of evidence indicates that use of LES [low-energy sweeteners] in place of sugar, in children and adults, leads to reduced EI [energy intake] and BW [body weight], and possibly also when compared with water.
  • Conflict of interest: Peter J Rogers has received grants from Sugar Nutrition, UK in support of research on the effects of sugar on human appetite. Cees de Graaf has received grants from the Dutch Sugar Bureau in support of a study on brain responses to sugars and low energy sweeteners. Suzanne Higgs has received a grant from Canderel in support of research on the effects of low-energy sweeteners on human appetite. Anne Lluch and David J Mela are employees and shareholders of companies that manufacture products containing sugars and low-energy sweeteners. Peter Putz is an employee of ILSI Europe.

Walnut ingestion in adults at risk for diabetes: effects on body composition, diet quality, and cardiac risk measures Valentine Yanchou Njike, Rockiy Ayettey, Paul Petraro, Judith A Treu, David L Katz.  . BMJ Open Diabetes Research and Care 2015;3:e000115. doi:10.1136/bmjdrc-2015- 000115.

  • Conclusions: The inclusion of walnuts in an ad libitum diet for 6 months, with or without dietary counseling to adjust calorie intake, significantly improved diet quality, endothelial function, total and LDL cholesterol, but had no effects on anthropometric measures, blood glucose level, and blood pressure.
  • Funding: Funding for this study has been provided by the California Walnut Commission.
  • Competing interests. DLK has been compensated for public speaking by the California Walnut Commission.
Sep 3 2015

Five more industry-funded studies with predictable results. Score since March: 52:1

Energy flux: staying in energy balance at a high level is necessary to prevent weight gain for most people.  Gregory A Hand, Robin P Shook, James O Hill, Peter R Giacobbi, and Steven N Blair.   Expert Rev. Endocrinol. Metab.  Early online, 1–7 (2015)

  • Conclusion: Maintaining energy balance at a higher caloric intake and expenditure should be a more successful long-term strategy for weight maintenance than reduced consumption or extreme caloric restriction at a low level of energy expenditure (a low energy flux) and improve intervention effectiveness for sustainable methods for body weight stability. [Implication: eat more to lose weight?]
  • Funding: GA Hand received non-restricted research funding and travel grant from The Coca Cola Company and a travel grant from International Life Sciences Institute. RP Shook received a travel grant from the Coca Cola Company. JO Hill received research support from the Coca Cola Company and the American Beverage Association. JO Hill is on the advisory board for McDonalds, General Mills, Curves, Consumer Goods Association, Calorie Control Council, International Food Information Council and McCormick Science Institute. JO Hill is a consultant for Walt Disney, has equity in Gelesis and Active Planet and is on the Board of Directors for International Life Sciences Institute and Livewell Colarado. SN Blair is the principal investigator on projects supported by unrestricted research grants from The Coca Cola Company to the University of South Carolina.
  • Comment: Some of these investigators were among those highlighted in the New York Times article revealing Coca-Cola’s funding of research demonstrating that physical activity is more important than diet in weight maintenance.

Reducing obesity will require involvement of all sectors of society. James O. Hill, John C. Peters and Steven N. Blair. Obesity Volume 23, Issue 2, February 2015, Page: 255.

  • Conclusion: If the physical inactivity industry could commit to increasing physical activity by 78 calories a day per person, we would begin seeing some real success…we need innovative thinking, recognition that both food and physical activity are important, and open minds about how to engage all of society in making changes.
  • Disclosure: Dr. Hill reports personal fees from Coca-Cola, personal fees from McDonald’s, grants from American Beverage Association, personal fees from Walt Disney Company, personal fees from General Mills, personal fees from Calorie Control Council, other from International Life Sciences Institute, and other from Retrofit outside the submitted work. In addition, Dr. Hill has a patent Energy Gap issued. Dr. Blair reports grants from Technogym and grants from Coca-Cola. Dr. Peters has no competing interests to disclose.
  • Comment: same investigators as in previous example.

Instant Oatmeal Increases Satiety and Reduces Energy Intake Compared to a Ready-to-Eat Oat-Based Breakfast Cereal: A Randomized Crossover Trial. Candida J. Rebello MS, RD, William D. Johnson PhD, Corby K. Martin PhD, Hongmei Han MS, Yi-Fang Chu PhD, Nicolas Bordenave PhD, B. Jan Willem van Klinken MD, PhD, Marianne O’Shea PhD & Frank L. Greenway MD.  Journal of the American College of Nutrition Published online: 14 Aug 2015.  DOI:10.1080/07315724.2015.1032442

  • Conclusion: Oatmeal suppresses appetite, increases satiety, and reduces energy intake compared to the RTEC [ready-to-eat cereal].
  • Funding: The trial was funded by Quaker Oats Center of Excellence and PepsiCo R&D Nutrition….

Impact of equol-producing capacity and soy-isoflavone profiles of supplements on bone calcium retention in postmenopausal women: a randomized crossover trial.  Jessica W Pawlowski, Berdine R Martin, George P McCabe, Linda McCabe, George S Jackson, Munro Peacock, Stephen Barnes, and Connie M Weaver. Am J Clin Nutr September 2015 vol. 102 no. 3 695-703.

  • Conclusion: Soy isoflavones, although not as potent as risedronate [a drug used to treat osteoporosis], are effective bone-preserving agents in postmenopausal women regardless of their equol-producing status, and mixed isoflavones in their natural ratios are more effective than enriched genistein.  [Equol is an isoflavone produced by intestinal bacteria]
  • Conflicts: CMW is on the scientific advisory board of Pharmavite [the maker of SoyJoy]. SB has a US patent on the use of conjugated isoflavones and the prevention of osteoporosis.

Agave Inulin Supplementation Affects the Fecal Microbiota of Healthy Adults Participating in a Randomized, Double-Blind, Placebo-Controlled, Crossover TrialHannah D Holscher, Laura L Bauer, Vishnupriya Gourineni, Christine L Pelkman, George C Fahey, Jr., and Kelly S Swanson. J. Nutr. 2015; 145:2025-2032 doi:10.3945/jn.115.217331

  • Conclusions: Agave inulin supplementation shifted the gastrointestinal microbiota composition and activity in healthy adults. Further investigation is warranted to determine whether the observed changes translate into health benefits in human populations.  [Note: Agave inulin is a prebiotic, a fiber that can be metabolized by intestinal bacteria.  The study reports enrichment of fecal Bifidobacterium (the good kind)].
  • Funding: Supported in part by Global Nutrition R&D, Ingredion Incorporated, Bridgewater, NJ.  V Gourineni and CL Pelkman are employees of Global Nutrition R&D, Ingredion, Incorporated.  [Ingredion manufactures prebiotic fibers]

As always, please send examples, particularly of industry-funded studies that do not produce results in the sponsor’s interest.

Aug 17 2015

Coca-Cola’s partnership with cooperative scientists: a cartoonist’s take

Now cartoonists are producing their own interpretations of the revelations in the New York Times of Coca-Cola’s funding of scientists to argue that what you drink has far less to do with obesity than does how much you move.

In Sunday’s Times, Brian McFadden comes to this conclusion:
Capture2Here’s the entire strip

Capture1:

 

 

 

 

 

The Global Calorie Balance Network (GEBN) scientists say they will have a response to all the criticism (and now ridicule).

GEBN welcomes the opportunity to engage in a global debate and discussion on the science and application of energy balance to promote health and reduce chronic disease. GEBN also welcomes scrutiny and constructive criticism. We respect our critics and ask that they respect us in return. The recent media attention has raised important issues about the goal and mission of GEBN. We have taken these comments very seriously and are in the process of clarifying these issues here on our website. We will have that information available early this week.

I look forward to seeing it.

Aug 27 2011

The Lancet’s series on obesity

The British journal, The Lancet, has a special series of papers on obesity and obesity policy, just out.

Don’t miss the Body Weight Simulator! It’s great fun to play with while waiting out a hurricane.

You type in your age, weight, and height (you can change the metrics to pounds and inches), and indicate your activity level.  It tells you how many calories you can eat every day to maintain that weight (Yikes!  That’s all? No wonder I have so much trouble).

It also tells you how many calories you need to reduce in order to lose weight over whatever time period you specify.

And here are the papers, reviews, and commentaries (you will need to log in to read more than the summary):

The future challenge of obesity
David King
Full Text | PDF

Reversing the tide of obesity
William H Dietz
Full Text | PDF

Where next for obesity
Harry Rutter
Full Text | PDF

The global obesity pandemic: shaped by global drivers and local environments
Boyd A Swinburn, Gary Sacks, Kevin D Hall, Klim McPherson, Diane T Finegood, Marjory L Moodie, Steven L Gortmaker
Summary | Full Text | PDF

Health and economic burden of the projected obesity trends in the USA and the UK
Y Claire Wang, Klim McPherson, Tim Marsh, Steven L Gortmaker, Martin Brown
Summary | Full Text | PDF

Quantification of the effect of energy imbalance on bodyweight
Kevin D Hall, Gary Sacks, Dhruva Chandramohan, Carson C Chow, Y Claire Wang, Steven L Gortmaker, Boyd A Swinburn
Summary | Full Text | PDF

Changing the future of obesity: science, policy, and action
Steven L Gortmaker, Boyd A Swinburn, David Levy, Rob Carter, Patricia L Mabry, Diane T Finegood, Terry Huang, Tim Marsh, Marjory L Moodie
Summary | Full Text | PDF