Search results: smart choices

I am an advisor to the American Society of Nutrition’s Early Career Nutrition group and was asked to address this question for its spring/summer newsletter (my piece starts on page 9).  Here’s what I said:

As a newly appointed advisor to ASN’s Early Career Nutrition (ECN) group, I am pleased to be asked to explain why I do not think it a good idea for nutrition scientists, practitioners, and societies to be funded by food, beverage, and supplement companies (collectively, the food industry) for research that is in any way related to their products. If we do, we run the risk of appearing as if our interests are conflicted. More than that, we risk being conflicted—influenced to be less critical or silent about nutrition issues related to the donor’s products. There is no getting around it: whatever the reality of the relationship, taking money from a for-profit food company makes us appear to be supporters of whatever products the company sells.

I worry a lot that financial ties between food companies and ASN tarnish its reputation and ours. It troubles me when critics outside our profession view us as “on the take” and publish reports exposing ASN’s financial ties to companies that have a marketing stake in what we study or say about their products. When ASN meetings are sponsored by food companies, it makes these financial ties seem normal. ASN provides a platform for industry-sponsored sessions such as the one this year on the benefits of Stevia, but you can bet they don’t include speakers who might say anything critical. Sponsorship excludes that possibility.

Most of what we know about the effects of sponsorship comes from a very large body of research on funding by the cigarette, chemical, pharmaceutical, and medical device industries. The results of this research are remarkably consistent: they demonstrate that industry funding influences the design, interpretation, and outcome of research. Nutrition is late to this type of investigation, but several recent studies show that studies funded by the food industry almost invariably favor the interests of the sponsor. Publication bias against negative studies explains only a small part of these findings.

Industry funding of nutrition research is an important issue where there are diverse opinions. ASN is a welcoming place encouraging discussion from members with all perspectives on topics including this one. ASN members share a common unifying goal of advancing nutrition science to promote the public welfare. Working together we can and we will continue to disclose potential conflicts of interest and advance the field for the public benefit. Dr. Mary Ann Johnson, ASN President
Investigators who take such funding insist that it has no effect on the design, conduct, interpretation, or publication of their research. This insistence is consistent with another large body of research demonstrating that gifts have a profound influence on attitudes, behavior, and action–but that recipients are blind to these effects. The medical literature shows that even small gifts—pens and pads—are enough to influence prescription practices, and that larger gifts have even greater effects. But the influence occurs below the radar of critical thinking. It is unintentional, unconscious, and unrecognized.

What most troubles me is the lack of questioning of industry penetration into our societies and research. I think we should be raising questions about ASN’s involvement with companies whose profits might be affected by our opinions or research results. Should ASN have competed to manage the industry-funded Smart Choices program that ended up putting a seal of approval on Froot Loops? Does it make sense for ASN to endorse public policy statements promoting the benefits of processed foods or opposing “added sugars” on food labels? Is it reasonable for ASN to argue on social media that it is inappropriate to question industry funding of research? Must ECN sessions at the annual meeting really be funded by companies such as PepsiCo (last year) or Abbott Laboratories? These actions send the message that ASN is an arm of the food industry and that we uncritically support what it makes, sells, or does.

But let’s turn to a more immediate concern: research funding. As early investigators, you face intense pressures to bring in external grants to pay for your studies, overhead, and maybe even your salaries. Government funding for many areas of nutrition research is declining. These pressures are real. But just as real are the effects of industry funding on research.
From March 2015 to March 2016, I posted summaries of industry-funded studies on my blog. During that year, I collected 168 studies. Of these, 156 yielded results favoring the sponsor’s interests. I only could find 12 studies that did not. This was a casually collected convenience sample but it did allow one conclusion: it is easier to find industry-funded studies with positive results than those with negative results. Nevertheless, recent systematic studies come to the same conclusion. Studies funded by Coca-Cola, for example, are far more likely to conclude that its products have no effect on obesity or type 2 diabetes than do studies funded by government or foundations.

Because we are generally unconscious of the influence of financial ties, it is easy for us to deny the influence or argue that nonfinancial interests—preferences for hypotheses and desires for career advancement–are just as biasing. Yes they may be biasing, but all scientists have them. In contrast to financial ties to industry, it is not possible to eliminate nonfinancial biases and still do science.

I am often asked whether there is a way to take money from food companies and maintain intellectual independence and professional reputation. I regret that I cannot think of any viable way to do that. The ASN has appointed a “Truth” commission to examine this issue and I look forward to its report. In the meantime, I am hoping that you will give thought to the potential conflict of interest and reputational loss that you risk with food industry ties. You must figure out for yourself whether you think the risks are worth taking.

If you do decide to engage with industry, you will need to disclose it. Most journals now require authors to reveal who pays for their work, but even when done diligently, disclosure is not sufficient to alert readers to the extent to which industry funding influences research outcome and professional opinion. Yes, disclosure is uncomfortable, perhaps explaining why so many studies identify frequent lapses. It is likely to become more uncomfortable. In response to a petition from the Center for Science in the Public Interest (which I co-signed), the National Library of Medicine has announced that it will henceforth add funding disclosures and conflict-of-interest statements to PubMed abstracts.

It is only fair to tell you how I handle these issues. My disclosure statement says:

Dr. Nestle’s salary from NYU supports her research, manuscript preparation, Website, and blog at https://foodpolitics.com. She also earns royalties from books and honoraria from lectures to university and health professional groups about matters relevant to this topic.” I also on occasion speak to food industry groups. When I do, I accept reimbursements for travel expenses but ask that honoraria be donated to the NYU library’s food studies collection.

This policy, imperfect as it may be, is the best I can do. I ask only that you think seriously about these issues and figure out for yourself how best to deal with them. I am happy to discuss these matters and am most easily reached at marion.nestle@nyu.edu.

References

• Nestle M. Food company sponsorship of nutrition research and professional activities: A conflict of interest? Public Health Nutrition 2001;4:1015-22.
• Nestle M. Corporate funding of food and nutrition research: science or marketing? JAMA Internal Medicine 2016;176(1):13-4.
• Krimsky S. Science in the Private Interest: Has the Lure of Profits Corrupted Medical Research. Rowman and Littlefield, 2004.
• Lo B, Field MJ, eds. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
• Simon M. Nutrition Scientists on the Take from Big Food. Eat Drink Politics and the Alliance for Natural Health, Jun 2015.

When the New York Times published an article describing Coca-Cola’s financial sponsorship of university researchers who de-emphasize the role of sugary drinks in raising the risk of obesity and type 2 diabetes, it kicked up a storm.

USA Today’s editorial board said:

It isn’t that companies pay scientists to put out false research. It’s that companies fund the work of scientists who happen to be doing research that spurs consumers to look away from science that hurts corporate interests.

Soft drinks are far less dangerous than cigarettes, but GEBN’s website, tweets and videos come right out of Big Tobacco’s playbook, brought into the digital era. Its leaders have done research in the past under about $3 million in grants given to their universities.

USA Today also printed a response by a Coca-Cola spokesman:

A recent New York Times article created confusion about our support of research and non-profit organizations, stating we want people to think that only exercise matters and not diet — but nothing could be further from the truth. We have always operated under the fact that a healthy, balanced diet and regular exercise are key ingredients for a healthy lifestyle.

That said, we need to do a better job of being even more transparent about the research we fund, the non-profit organizations we support and the way we publicly share this information. And we will.

Yesterday, Senator Richard Blumenthal sent letters to the University of Colorado, West Virginia University, and the University of South Carolina urging them to  clarify the nature of the University’s relationship with projects funded by Coca-Cola and to review the academic integrity of such grant agreements.

I believe your university must determine whether this research is in effect promoting a predisposed and biased agenda, rather than reflecting the impartiality and objectively (sic) expected from a public academic institution.

Years of litigation with tobacco companies were necessary to fully expose the tragic public health consequences when companies lie about the hazards of the products they sell.  I am deeply concerned that we may force future generations to relive this history if corporate-sponsored studies devoid of scientific integrity are permitted once again to deceptively downplay and conceal the dangers of a product consumed on a mass scale.

Do not underestimate Senator Blumenthal’s ability to deal with food companies.  He, you may recall, was responsible for withdrawal in 2009 of the ill-conceived Smart Choices program during his stint as Connecticut’s attorney general.

I’m still waiting for the Global Calorie Balance Network to issue its promised statement.  Stay tuned.

I’m catching up with events I missed while offline in Cuba.  Here’s one: Michele Simon’s new report:

The American Society for Nutrition (ASN) is the leading organization for physicians and scientists who conduct nutrition research.  I’ve been a member for years and have long fretted about the ASN’s too-cozy relationships with food company sponsors (for example, see my posts on the ill-fated Smart Choices campaign and on a recent ASN annual meeting).

Simon has now done for the ASN what she previously did for the American Academy of Dietetics.

A few of her findings:

• Of the 34 scientific sessions at ASN’s annual meeting, 6 were supported by PepsiCo, and others were supported by the Egg Nutrition Center, Kellogg, DuPont Nutrition and Health, Ajinomoto, and the National Dairy Council.

• The International Life Sciences Institute (a front group for Big Food and Big Pharma) sponsored a session on low-calorie sweeteners; speakers included a scientific consultant for Ajinomoto, which produces aspartame.

• For $35,000, junk food companies can sponsor the hospitality suite at the annual meeting, where corporate executives socialize with nutrition researchers.

• ASN published an 18- page defense of processed food that consists of numerous talking points for the junk food industry, such as “There are no differences between the processing of foods at home or at a factory.”

• ASN opposes an FDA proposed policy to include added sugars on the Nutrition Facts panel, at a time when excessive sugar consumption is causing a national public health epidemic.

I’m quoted in the report:

I think it’s important that professional societies like ASN promote rigorous science and maintain the highest possible standards of scientific integrity. Research and education about food and nutrition are easily influenced by funding from food companies but such influence often goes unrecognized. This means that special efforts must be taken to avoid, account for, and counter food industry influence, and organizations like ASN should take the lead in doing so.

The report has been well covered by the media:

• Leading U.S. Nutrition Scientists Forge Cozy Relationships With Major Food Companies and Lobbying Groups, Report Charges, International Business Times
• Is the Leading Nutrition Science Group in Big Food’s Pocket? Mother Jones
• Do big food companies have too much sway over nutrition research? WBEZ Radio
• Report Questions Nutrition Group’s Ties to Food Companies, Food Manufacturing
• Food companies, nutrition researchers getting too friendly: report, FoodDive
• And see the lengthy online rebuttal

Relations between nutrition scientists and food companies worry me.  Here’s another example: Portuguese nutritionists have produced an e-book extolling the virtues of cereal-based drinks.  The book is sponsored by Nestlé (the company, not me).  Nestlé, no surprise, is the market leader for these products in Portugal.  I thank Vladimir Pekic of BeverageDaily.com for finding this one.

As reported in today’s New York Times, the Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association) has licensed its Kids Eat Right seal to—get this— Kraft Singles.

But no, AND says, this is not an endorsement.  Kraft is merely a “proud supporter of” AND’s Kids Eat Right program.

As the Times understates the matter,

Over the last few years, the academy been criticized from some of its members and health advocates over what they contend are its overly cozy ties to industry.

Kraft is well known as a sponsor of AND.  Such seals are usually money-raising gimmicks.

I’m wondering if “proud supporter of” means that Kraft pays AND for use of this seal. If so, I’d like to know what the seal costs.

AND members: do any of you know?

Recall the debacle over the Smart Choices logo some years ago.

The press had a field day with the Smart Choices logo on Froot Loops.  As Rebecca Ruiz at Forbes puts it, “the uproar over the program has conveyed a definitive message to industry: Don’t try to disguise a nutritional sin with a stamp of approval.”

Somehow, Kraft and AND seem to have missed this lesson.

Additions: Andy Bellatti sends these links to a statement from Sonja Connor, AND’s president and the website describing the program.

Thanks to Yoni Freedhoff for sending this explanation:

 

And this enlightening note from ABC News:

The academy…said the appearance of the logo on the processed cheese product is not an endorsement or seal of approval. It’s more like an ad for Kids Eat Right, according to the academy, though, in a reversal of how most ads work, Kraft paid the advertiser — the academy — an undisclosed amount to place the logo.

Over the weekend, Politico announced that the Grocery Manufacturers Association (GMA) and Food Marketing Institute (FMI) were finally going to launch their long-threatened $50 million campaign to promote voluntary “Facts Up Front” labels on food packages.

In case you never noticed these labels—and I doubt most people do—here is an example:

GMA and FGI conducted their own survey.  This—no surprise—found that people love Facts Up Front labels, but I find that hard to believe.  Neither do others, according to Politico reporters.

For what $50 million will buy, see yesterday’s Washington Post, page A5 (thanks Politico).

Recall the history

Facts Up Front (formerly known as Nutrition Keys), was originally launched as an end run around what the FDA was then trying to do with front-of-package labeling initiatives.  This happened early in 2011.

The GMA/FMI ploy brought the FDA’s initiatives to a halt—despite the agency’s investment in two Institute of Medicine (IOM) studies to establish a research basis for front-of-package labels.

These, in turn, followed on the heels of the food industry’s ill-fated Smart Choices—an attempt to promote highly processed foods as healthy.

GMA/FMI’s goal was to head off any possibility that the FDA would mandate red, yellow, and green traffic light signals.

Red signals might discourage consumers from buying products made by the companies GMA and FMI represent.

The food industry had cause to worry.  The IOM was considering—and eventually published—a front-of-package scheme similar to traffic lights.  It used checks or stars to evaluate the content of calories, saturated and trans fat, sodium, and sugars, all nutrients to watch out for.

GMA/FMI got its much more complicated—and, therefore, harder to understand—Nutrition Keys out first.  This preempted the IOM recommendations.

The FDA gave up.  The two IOM reports went into a drawer and the FDA has done nothing with them.

Why is GMA/FMI doing this now?

Surely, it is no coincidence that GMA/FMI is rolling out this campaign on the heels of Let’s Move!’s triumphant release of the FDA’s new food labeling proposals.

They must be worried that the FDA will unearth the two IOM reports, adopt the IOM recommendations, and start rulemaking for front-of-package labeling.

One sign of the food industry’s strategy comes from Bruce Silverglade, who for years was head counsel for the Center for Science in the Public Interest (CSPI), but has now revolved to a Washington, DC law firm that represents food companies.  He told Politico:

The general view in the industry is that nutrition information has really moved to the front of the pack. What FDA is doing is essentially proposing a new model of an old dinosaur.

As Michele Simon tweeted: “that comment…is rich coming from ex-@cspi lawyer who fought for label.”

What’s wrong with Facts Up Front? 

Plenty.

The IOM recommended that front-of-package labels be:

• Simple: easy to understand
• Interpretive: putting judgments in context
• Scaled: indicating good, better, and best

Facts Up Front does none of the above.

Facts Up Front is a tool for selling, not buying.

Its purpose is to make highly processed foods look healthier, whether or not they really are.

Whether slightly better-for-you processed foods will help anyone make better food choices and be healthier remain open questions.

What should happen now?

With Let’s Move! really moving, this seems like a great time to urge the FDA to pull out those IOM reports and get busy on a front-of-package labeling method that will really help the public make healthier dietary choices.

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

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

Let me clarify:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

My monthly (first Sunday) Food Matters column in the San Francisco Chronicle appears today.  This time, it’s about the fuss over front-of-package labels.

Q: I’m completely confused by all of the little check marks and squares on food packages telling me they are healthy. Do they mean anything?

A: The Food and Drug Administration feels your pain. It sponsored two studies by the Institute of Medicine to rationalize front-of-package nutrition ranking systems.

The institute released its second report last month; it advises the FDA to allow front-of-package labels to state nothing but calories and nutrients to avoid: saturated and trans fat, sodium and sugar (go to sfg.ly/sUptQR).

The institute’s proposal gives products one point for not containing too much of each of these nutrients. It suggests displaying the points like Energy Stars on home appliances with zero to three stars, depending on how well the product meets nutritional criteria.

This is a simple system, instantly understandable. I think it is courageous. The institute’s proposal benefits consumers. It does not help companies sell junk food.

Selling or educating?

No food company wants to display nutrients to avoid. For the food industry, the entire point of front-of-package labels is to market products as healthy or “better for you” no matter what they contain. Front-of-package labels are a tool for selling, not buying. They make highly processed foods look healthier.

Will companies accept a voluntary labeling scheme that makes foods seem worse? Doubtful.

Nutrition ranking symbols began appearing on food packages in the mid-1990s, when the American Heart Association got companies to pay for displaying its HeartCheck.

Food companies then established their own systems for identifying “better-for-you” products. PepsiCo, for example, developed its own nutritional standards and proclaimed hundreds of its snacks and drinks as “Smart Choices Made Easy.”

In an attempt to bring order to this chaos, food companies banded together to develop an industry-wide system. Unfortunately, their joint Smart Choices checkmark appeared first on Froot Loops and other sugary cereals. The ensuing ridicule and legal challenges forced the program to be withdrawn.

At that point, the FDA, backed by Congress and other federal agencies, asked the Institute of Medicine for help.

The institute released its first report last year. It revealed inconsistencies in the 20 existing ranking schemes from private agencies, food companies and supermarket chains. Toasted oat cereal, for example, earned two stars in one system, a score of 84 (on a scale of 100) in another, and a score of 37 in a third.

The report said labels should display only calories and to-be-avoided nutrients. Labels should not display “good-for-you” nutrients – protein, fiber, and certain vitamins and minerals – because these would only confuse consumers and encourage companies to unnecessarily add nutrients to products for marketing purposes.

Although the FDA was waiting for the second institute report before taking action, the food industry wasted no time. The Grocery Manufacturers Association and Food Marketing Institute introduced their own system.

Complicated approach

They got their members to agree to a more complicated system, “Nutrition Keys,” based on nutrients to avoid but also including up to two “good-for-you” nutrients.

Food companies immediately put Nutrition Keys’ symbols – well established to be difficult for consumers to understand – on package labels where you can see them today. Now called Facts Up Front, the symbols are backed by a $50 million “public education” campaign.

The reasons for the industry’s preemptive strike are obvious. The second Institute of Medicine report gives examples of products that qualify for stars – toasted oat cereal, oatmeal, orange juice, peanut butter and canned tomatoes, among them.

It also lists the kinds of products that would not qualify for stars, including animal crackers, breakfast bars, sweetened yogurt and chocolate milk.

So the industry argues that consumers “want simple and easy to use information and should be trusted to make decisions for themselves and their families … rather than have government tell them what they should and should not eat.”

But why, you ask, does any of this matter? I view front-of-package labels as a test of the FDA’s authority to regulate and set limits on any kind of food industry behavior. If the FDA cannot insist that food labels help the public choose healthier foods, it means the public has little recourse against any kind of corporate power.

Perhaps Facts Up Front will arouse the interest of attorneys general – just as the Smart Choices program did.

In the meantime, the industry’s pre-emption of FDA labeling initiatives is evidence that voluntary schemes don’t work. Labeling rules need to be mandatory.

Let’s hope the FDA takes the Institute of Medicine’s advice and starts rule-making right away.

Marion Nestle is the author of “Food Politics” and “What to Eat,” among other books, and is a professor in the nutrition, food studies and public health department at New York University. E-mail comments to food@sfchronicle.com.

Food Navigator’s “special edition” on front-of-package labeling includes the results of a new survey of readers’ attitudes and a round up of previous articles.

Front-of-pack poll results: No clear winner (except cynicism…): The results of this poll are amusing, not least because they depend—as always—on how the questions were asked.   Respondents to this one were offered five choices:

• Facts up Front. Consumers don’t want to be told what to eat (29% picked this one).
• The IOM scheme. Busy shoppers need more guidance (19%).
• Other points-based schemes that include positive nutrients. eg. Guiding Stars (11%).
• Traffic-light-type color-coding schemes (~5%).
• We’re kidding ourselves if we think front-of-pack labels will change behavior (36%).

This last is tempting.  Front-of-package labels, as I keep insisting, are about encouraging sales of one processed food product over another.  They have little to do with encouraging healthier food choices.

Front-of-pack labeling in pictures: Healthier choices at a glance or more nutritional wallpaper?: Red lights, green dots, ticks, stars, healthy seals, nutrients to encourage, nutrients of concern, smart choices… The aim of front-of-pack labels is simple – to help us make healthier choices (or at least more informed ones) – fast. But how best to achieve this has prompted a storm of controversy on both sides of the Atlantic….

IOM front-of-pack labels are step in right direction but need more work, says Guiding Stars advisor: The Institute of Medicine’s (IOM’s) proposed front-of-pack (FOP) labeling scheme is a positive step forward, but “needs much more work”, according to supporters of one leading FOP scheme already up and running in the marketplace….

IOM front-of-pack labeling scheme: It’s bold, it’s simple and I love it. But is it fair?: The Institute of Medicine (IOM) certainly didn’t pull any punches in its front-of-pack labels report yesterday….

IOM calls for ‘fundamental shift’ in approach to front-of-pack food labeling: Front-of-pack (FOP) labeling schemes should “move away from systems that mostly provide nutrition information without clear guidance about healthfulness and toward one that encourages healthier food choices”, according to a high-profile report from the Institute of Medicine (IOM)….

Not a word from the FDA about the IOM’s front-of-package report.  What will FDA do?  What can FDA do?  It’s a voluntary scheme and companies can voluntarily refuse to use it.  Hence: those useless (except to food companies) “Facts Up Front.”