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POM Wonderful has a full-page ad in today’s New York Times (how much do these things cost?) titled “FTC v. POM: You be the judge.”  The ad includes selected quotes from the judge’s decision (see yesterday’s post) and refers readers to its wonderfully named website, pomtruth.com, where you can see the quotes and the ads for yourself.

I couldn’t help doing some checking.

The POM ad quotes from Chief Administrative Law Judge’s decision:

Competent and reliable scientific evidence supports the conclusion that the consumption of pomegranate juice and pomegranate extract supports prostate health, including by prolonging PSA doubling time in men with rising PSA after primary treatment for prostate cancer (page 282).

I turned immediately to page 282.  The sentence before the one quoted would seem to support it:

The basic research, the Pantuck Study, and the Carducci Study, relied on by Respondents [POM Wonderful], support the conclusion that pomegranate juice has a beneficial effect on prostate health.

But what follows the quotation makes it clear that although the research claims to support the effect, it really doesn’t.  Here’s what immediately follows the quotation in the same paragraph:

However, the greater weight of the persuasive expert testimony shows that the evidence relied upon by Respondents is not adequate to substantiate claims that the POM Products treat, prevent, or reduce the risk of prostate cancer or that they are clinically proven to do do so.  Indeed, the authors of the Pantuck Study and the Carducci study each testified that their study did not conclude that POM juice treats, prevents, or reduces the risk of prostate cancer.  And, as Respondents’ expert conceded, no clinical studies, research and/or trials show definitely that the POM Products treat, prevent, or reduce the risk of prostate cancer.

I will just do one more of the quotes.  The ad says:

Competent and reliable scientific evidence shows that pomegranate juice provides a benefit to promoting erectile health and erectile function (page 198).

This is indeed on page 198 but is followed immediately by:

There is insufficient competent and reliable scientific evidence to show that pomegranate juice prevents or reduces the risk of erectile dysfunction or has been clinically proven to do so…There is insufficient competent and reliable scientific evidence to show that pomegranate juice treats erectile dysfunction in a clinical sense or has been clinically proven to do so.

Because these statements are attributed to the same expert witnesses, this must mean that while some studies show benefits, the experts do not believe that these studies (many of them sponsored by POM) are scientifically credible.

Pomegranate juice is a juice.  Fruit juices are healthy and especially delicious when fresh.  I happen to like the taste of pomegranate juice.

But does it have any special health benefits as compared to orange, grapefruit, grape, or any other fruit juice?

Would any fruit juice be likely to prevent heart disease or prostate problems on its own?

Despite POM’s out-of-context advertisement, the Administrative Law Judge did not think so, and neither do I.

Addition: I’m indebted to FoodNavigator.com for noticing some of the other ads.

The caption reads: “Natural Fruit Product with Health Promoting Characteristics–FTC Judge.”

I’ve been following the legal battles between the Federal Trade Commission (FTC) and the makers of POM juice and other pomegranate juice products with avid interest, mainly because they deal with the credibility of sponsored scientific research.

This week, an administrative law judge ruled that POM violated federal law when it deceptively advertised  its products as able to “treat, prevent, or reduce the risk of heart disease, prostate cancer, and erectile dysfunction.”

The judge ruled that reasonable consumers would interpret the ads as making such claims but that the company had not produced convincing evidence to support them.

The judge’s decision makes entertaining reading for someone like me who enjoys debates about whether sponsorship of scientific studies influences results and interpretation—as evidence shows they most definitely do.

POM has invested more than $35 million in research to prove that pomegranate juice has health benefits.  It has sponsored about 100 studies at 44 different institutions.  At least 70 of these studies were published in peer-reviewed journals.

It is not difficult to design research studies to give sponsors the answers they want and to make sure they are conducted well.  POM is getting the best research that money can buy.

One such study, of the effects of drinking pomegranate juice on myocardial perfusion (MP, blood flow to the heart), was conducted by Dr. Dean Ornish, who runs a preventive medicine institute in California (the quotes come from pages 268-269 of the decision).

The Ornish MP study was originally designed to last 12 months, with measurements at baseline, 3 months, and 12 months.  [The FTC] charges that the study was cut short when the three-month data came in favorably and Dr. Ornish faced cost overruns.

Dr. [Frank] Sacks [expert witness for the FTC] opined that the shortened study period and failure to report the planned duration are inconsistent with widely accepted standards for conduct of clinical trials and undermine any confidence in the findings.

Dr. Ornish testified that the Ornish MP Study was terminated after three months only because the Resnicks did not provide the funding that they had previously committed to this study….[he said the study]constitutes credible and reliable science showing that pomegranate juice lessens the risk of cardiovascular problems.

The judge found evidence on this study and many others conflicting.  He ruled that this level of disagreement about the quality of the research means that the scientific evidence is not good enough to substantiate the claims.

I was interviewed for a story in Business Week about this decision.

This makes it clear why everyone should be suspicious of the results of sponsored studies…POM-sponsored studies produce results favorable to POM.

POM’s owners have their own spin on the decision.

It says the ALJ’s ruling affirms the scientific validity behind the general health benefits of pomegranates and “completely exonerates” POM regarding its claims in broadcast or print interviews.

Let’s be clear what’s at stake here.  According to the decision document, the owners of POM control 18,000 acres of pomegranate orchards.

From September 2002 through November 2010, sales of POM juice alone totaled nearly $248 million (the supplements and other products add more).

The owners must believe that nobody will buy pomegranate juice and supplements for any reason other than health benefits.

Health claims are about marketing, not health.

Let’s hope the FTC can make the decision stick.

This appeared in my e-mail.  I tried to find out where it came from, but no luck.  Can anyone tell me its source?

I haven’t said anything recently about the current status of the farm bill, mainly because it is too early in the political process to know what is going to happen.

On April 26, the Senate Ag Committee voted to pass the Agriculture Reform, Food and Jobs Act of 2012.

The bill still has a long way to go.  It must be passed by the Senate.  The House has to pass an equivalent bill.  The two bills must be reconciled.  The final bill must be signed by the President.

Otherwise, the current farm bill expires on September 30.

As is always the case with anything having to do with the farm bill, the devil is in the details.  The number of programs covered by the bill is vast, and the details even more so.

In efforts to align agricultural policy with health policy, the current proposal makes a little headway. The proposed bill funds:

• $150 million annually for the Fresh Fruit and Vegetable program
• $50 million per year for the Defense Department Fresh program, which provides fresh fruits and vegetables to schools and service institutions
• $70 million annually for the Specialty Crop Block Grant program
• $25 million annually for the Specialty Crop Research Initiative, to go to $50 million by 2017
• $60 million in 2013 up to $65 million 2017 for pest and disease management programs
• $200 million annually for The Market Access Program and $9 million for the Technical Assistance for Specialty Crops program
• $100 million over 5 years for the Hunger-Free Communities Grant Program for fruit and vegetable SNAP incentives
• $100 million over 5 years for the Farmers Market and Local Food Promotion Program
• $406 million annually for Section 32 specialty crop purchases

This looks like a lot—and from the standpoint of incremental change it is a lot—but these numbers are millions, not billions, and in farm bill terms can be considered “mere rounding errors.”

The farm bill currently costs taxpayers $85 billion a year, with $72 billion of that going for SNAP (food stamp) benefits.

The rest of the big money goes to the Big Agriculture growers of commodity crops, mainly in the form of crop insurance.

Here too, the proposed bill includes one small but significant measure.  For the first time, it provides for crop insurance for diversified farms—those that grow a variety of  “specialty” crops (translation: fruits and vegetables).

Even the most critical commentators think the current proposal, despite its evident flaws, represents the best that can be expected given current political realities.

Let’s hope the good parts of the proposal survive the rest of the legislative process.

Addition, May 24: A reader points out that another bright spot is that the Senate bill also included $125 million for the Healthy Food Financing Initiative.

Sandor Ellix Katz, The Art of Fermentation: An In-Depth Exploration of Essential Concepts and Processes from Around the World, Chelsea Green, 2012.

This is a big book—498 pages—packed full of anything you’d want to know about fermented foods, not only as something healthful we seem to have evolved with, but also as something delicious to eat and drink.  Think: cheese, yogurt, sourdough, beer, kimchi, and soy sauce, but also such exotica as kombucha candy or cod liver oil.  The book’s coverage is international, the directions explicit (equipment, gear, troubleshooting), and the design beautiful.  Michael Pollan’s introduction says he found it inspirational.  Me too.

Peter Kaminsky, Culinary Intelligence: The Art of Eating Healthy (and Really Well), Knopf, 2012.

I blurbed this one:

Kaminsky’s rules for taking pounds off and keeping them off are based on a really good idea: Flavor per Calorie.  That works for him and should make dieting a pleasure.

You can eat well and healthfully and everywhere if you apply your inborn Culinary Intelligence.  Kaminsky says the CI story can be summarized in ten words: Buy the best ingredients you can afford.  Cook them well.

Can’t beat that.

Seamus Mullen, Hero Food: How Cooking with Delicious Things Can Make Us Feel Better, Andrews McNeel, 2012.

I don’t usually blurb cookbooks, but it wasn’t hard to talk me into doing this one.

Take a look at what Seamus Mullen does with vegetables, fruit, grains and everything else he cooks.  I can’t wait to try his 10 Things to Do with Corn.  His food can’t guarantee health, but it will surely make anyone happy.

This gorgeous book proves without a doubt the point I’ve been making for years: healthy food is delicious!

Mullen cooks Spanish food at Tertulia, Manhattan.  The food is delicious (but bring ear plugs!).

I’ve been asked to comment on the HBO series, Weight of the Nation and everything that comes with it: the accompanying book, the auxiliary videos, the distribution plan to schools and other institutions, and the Institute of Medicine’s report, Accelerating Progress in Obesity Prevention.

Because I wanted to look at all of it before commenting, plenty of others have beaten me to it, among them FoodandTechConnect’s infographic summary,   Kerry Trueman on AlterNet and Michele Simon on Grist.

I don’t have HBO but got sent the press kit, the Weight of the Nation book, the disks, and the IOM report.  I watched all four hours of the HBO series, plus the “Rethinkers” video of kids working on a school lunch project in New Orleans (air dates), plus the IOM and HBO books, plus the website.

Overall, Weight of the Nation makes the size, scope, causes, and consequences of obesity alarmingly clear.

The talking heads—many of them my friends, colleagues, and former students—all had plenty to say about what obesity means on a day-to-day basis for individuals and its personal and economic cost to society.

The programs ought to convince anyone that obesity is a big problem and that something big needs to be done to prevent it.

But doing something big, the series makes clear, will be very difficult.

This may be realistic, but it is not inspiring.

We need inspiration.   That’s why I wish the programs had focused as much on social responsibility as they did on personal responsibility.

I wanted to see the programs take leadership on how government can help citizens reduce the social, economic, and business drivers of obesity.

That kind of leadership exists.  To see it in action, watch the video of the New Orleans school “rethinkers.”  Those kids wanted to improve their school lunches.  They got busy, dealt with setbacks, and learned how to make the system work for them.  They “spoke truth to power” and “held feet to the fire.”

Why aren’t adults doing the same?   Politics, the IOM report explains.  Although one of its principal recommendations is critical—Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice—its recommendations speak some truth to power but do little to hold feet to the fire.

The IOM report explains the political realities:

The committee’s vision takes into account the need for strategies to be realistic, as well as consistent with fundamental values and principles.  At the same time, however, having a diversity of values and priorities among them is itself a principle of U.S. society.

Potentially competing values and principles must be reconciled, for example, in considering protections needed for individuals versus the community at large or for the public versus the private sector.

Vigilance regarding unintended adverse effects of changes undertaken to address the obesity epidemic is also needed.

“Americans,” the report says, are accustomed to the current obesogenic environment, one “driven by powerful economic and social forces that cannot easily be redirected.”

It may not be easy to redirect such forces, but shouldn’t we be trying?

In 1968 the CBS documentary Hunger in America galvanized the nation to take action to reduce poverty and malnutrition.

The HBO series was equally shocking but I wish it had focused more on how we—as a society—could mobilize public distress about the poor quality of food in schools and the relentless and misleading marketing of sodas and junk foods that it so well documented.

But dealing with the need to address the social and economic forces that promote obesity would, I’m told, be considered lobbying, which the private-public sponsors of the series are not permitted to do.

Mobilizing public support for health is considered lobbying.  Food industry marketing is not.

FoodNavigator-USA.com columnist Caroline Scott-Thomas wrote about the HBO series:

As an industry journalist, I’ll be among the first to admit that industry is stuck in a very hard position here: On the one hand, it wants to be seen to be doing the right things – but on the other, what people say they want to eat, and what they actually do eat are often very different, and after all, food companies are in the business of making money.

But honestly, could industry do more to make healthy choices routine, easy choices? I think so.

Yes it could, but won’t unless forced to.

Without leadership, we are stuck doing what the food industry needs, not what the public needs.

Weight of the Nation did an impressive and compelling job of defining the problem and its causes and consequences.  I wish it—and the IOM—could have risen above the politics and pressed harder for strategies that might help people make healthier choices.

But—if the HBO programs really do help mobilize viewers to become a political force for obesity prevention, they will have been well worth the effort that went into making and watching them.

In response to my post on tuna scrape, Professor Alan Reilly, Chief Executive, Food Safety Authority of Ireland (the equivalent of our FDA) sent this photograph of an actual tuna scrape label.

After I forwarded it to Bill Marler, he noticed that it is one of several photographs posted on the FDA’s tuna scrape recall web page).

The type is too small to read so I’ve done some cropping:

Professor Reilly asks:

What is puzzling me is why this product “minced tuna” was used in sushi products. The label (copy attached) clearly states that the product must be cooked before consumption and it is for industrial uses only (labelled not for retail).

Those are good questions, but here’s another, equally alarming.  What’s that strangely formatted Nutrition Facts label? It does not precisely follow FDA design or content requirements.

This is a red flag.  If the company is not following labeling rules, it might not be  following other rules either—safety, for example.

Safety?  Uh oh.

Bill Marler reports that the FDA “483 Inspection Report” on the Indian tuna processing facility is now available.  Read these quotes and shudder:

• Tanks used for storage of process waters have apparent visible debris, filth and microbiological contamination.
• There is no laboratory analysis for water used in ice manufacturing at the [redacted] facility to show the water used to make ice is potable.
• Apparent bird feces were observed on the ice manufacturing equipment at Moon Fishery; insects and filth were observed in and on the equipment.
• Tuna processed at your facility, which is consumed raw or cooked, comes in direct contact with water and ice.

I draw several lessons from this episode:

• Food is safer when cooked.
• Labels need to be read—and followed—carefully.
• Raw sushi is a high risk product, especially if it doesn’t cost much.
• The FDA needs to be doing a lot more inspecting of overseas facilities, and before they cause problems.

All of this means that we need a better food safety system, one that can address the enormous proportion of our food supply that comes to us from countries with weaker food safety standards.

Addition, May 17: Ben Embarek, a food safety scientist at the World Health Organization notes that the 483 report reveals that Moon’s HACCP plan did not list appropriate critical control points.  Anyone auditing the plan should have picked up the problems on paper, which is easier and less expensive to do than an on-site inspection.  But the FDA does not pre-audit international HACCP plans.  They are supposed to be cleared by exporting companies registered by FDA.  Comment: it’s hard to imagine that the current system can work, and it clearly does not.

While Weight of the Nation is airing on HBO this week (I’ll comment on it after it’s fully aired), here’s what happens when public health officials try to do something to make it easier for kids to eat more healthfully.

The Massachusetts public health department came up with a proposal to ban bake sales in public schools 30 minutes before, during and after classes.

The reaction?  An uproar.  The ban, according to critics, would

• Make it harder to raise money for class trips and athletic equipment
• Undermine the fundraising efforts of parent and student groups
• Not help prevent obesity
• Take away choice from school districts (“government gone awry”)

Under this kind of pressure, “the governor spoke, emergency orders were issued, and the Legislature voted.”

End of ban.

Massachusetts public health commissioner John Auerbach pointed out:

The school nutrition standards have always been about reducing childhood obesity in Massachusetts and protecting our kids from the serious long-term health impacts that obesity can cause…At the direction of Governor Patrick, the department will seek to remove these provisions.

We hope to return the focus to how we can work together to make our schools healthy environments in which our children can thrive.

Best of luck.

This reminds me of what happened in Texas, when Susan Combs, then state agriculture director, attempted to ban cupcakes from public schools.

As Dr. Cathy Isoldi described in her study of school celebrations earlier this year (on which I am a co-author),

Such bans have prompted intense opposition in many areas of the country. In Texas in 2005, a ban on food service during classroom celebrations elicited parent outrage and resulted in the addition of a Safe Cupcake Amendment to the state’s nutrition policy. The amendment, known as Lauren’s Law, ensures that parents and grandparents of schoolchildren celebrating a birthday can bring in whatever food items they choose for classroom celebrations.

Cathy’s work makes it clear that school celebrations alone can account for a whopping 20% to 35% of a child’s daily calorie needs.  This percentage does not account for additional treats sent home with children,  given to them by teachers as rewards, or purchased in school at bake sales.

You don’t see an occasional cupcake as a problem?  Read Bettina Siegel’s post on what goes on in her kids’ school and how often schoolkids are exposed to junk foods during the school day.

Of course kids will eat treats rather than healthier foods if given half a chance.  Isn’t it an adult responsibility—at home and at school—to make sure that kids eat healthfully?

The environment of many schools is anything but conducive to good health practices.  While outright bans may be seen as going too far, some kind of restriction on junk food in schools seems like a sensible adult decision, given the impact of obesity on children, families, and the health care system so well documented in Weight of the Nation.

State legislatures should be promoting such efforts, not overturning them.