Currently browsing posts about: Conflicts-of-interest

The newly alive Federal Trade Commission (FTC) says POM Wonderful must stop making unscientific claims for the health benefits of pomegranate juice.  POM juice, the FTC says, has not been shown to prevent or treat heart disease, prostate cancer, or erectile dysfunction, as the company claims:

“SUPER HEALTH POWERS! … 100% PURE POMEGRANATE JUICE. … Backed by $25 million in medical research.  Proven to fight for cardiovascular, prostate and erectile health.”

“NEW RESEARCH OFFERS FURTHER PROOF OF THE HEART-HEALTHY BENEFITS OF POM WONDERFUL JUICE.  30% DECREASE IN ARTERIAL PLAQUE … 17% IMPROVED BLOOD FLOW … PROMOTES HEALTHY BLOOD VESSELS … ”

“Prostate health…You have to be on pomegranate juice.  You have a 50 percent chance of getting [prostate cancer].  Listen to me.  It is the one thing that will keep your PSA normal.  You have to drink pomegranate juice.  There is nothing else we know of that will keep your PSA in check. … It’s also 40 percent as effective as Viagra.”

Clinical studies prove that POM Juice prevents, reduces the risk of, and treats, erectile dysfunction.

The complaint cites advertisements in the Washington Post and Fitness magazine, as well as this ad:

According to the New York Times account, the POM Wonderful folks are not taking this lightly.  They have spent a reported $34 million on research to “prove” that POM has antioxidant activity.

But I could have told them that before they spent a dime!  All fruits and vegetables have antioxidant activity.

I love using POM research as an example of how easy it is to design studies to give you the answer you want.  POM research demonstrates that pomegranate juice has antioxidant activity and acts as an antioxidant in the body.  Of course it does.

But so does every other fruit and vegetable and what this research does not do is compare the effects of pomegranate juice to those of orange juice, for example.     That’s the issue I talked about in my November 19, 2007 post titled “The (silly) battle of the antioxidants.”

Which fruit has the most antioxidants? The latest report says blueberries, followed by cranberries, apples, red grapes, and finally green grapes. What? Pomegranates don’t even make the top five? In this case, who knows? The investigators were testing a new assay method and those were the only fruits they examined.

And then there is the troubling matter of whether antioxidants make a demonstrable difference to health.  The European Food Standards Agency has been turning down health claims for antioxidants like mad.  As I discussed on April 16, 2009:

Here’s another example from the pomegranate folks.  They do brilliant advertising, but this time the British are complaining that these marketers went too far when they posted billboards stating that pomegranate (“antioxidant powerhouse”) juice will help you cheat death.  The British advertising standards agency balked.  Here too, pesky science gets in the way.  Studies not only fail to support a benefit of antioxidants but sometimes show harm.

If only that pesky science weren’t so inconvenient, marketers could do as they please.  The New York Times reports that the POM folks are not taking this lightly.  They are suing the FTC—not because they are claiming they have science on their side, but because they think their health claims, believable or not, are protected by the First Amendment.

Did our founding fathers really introduce the First Amendment to protect the right of marketers to make unsubstantiated health claims?  Do our judges really believe this?  Is this a good case for taking on this question.  Lawyers: get to work!

Corporations go to a lot of trouble to neutralize potential critics.   Recent examples: two co-optations (McDonald’s alliance with Weight Watchers and PepsiCo’s with the Yale School of Medicine) and one aggression (Disney’s forced expulsion of the Center for Commercial-Free Childhood from Harvard).

Co-optation is the winning over or neutralization of opponents by bringing them into the fold.  It works well.

Let’s start with the new partnership between Weight Watchers and McDonald’s.  OK.  This is happening in New Zealand, not here, but it is still a good example.  McDonald’s New Zealand makes three meals that meet criteria for 6 Weight Watchers’ points.    Will Weight Watchers New Zealand suggest that its members cut down on fast food?  Not likely.

Next, Yale.  Yale Medical School proudly announces that PepsiCo has agreed to fund a new fellowship.  This fellowship, which creates a new position in the MD-PhD program, is for doctoral work in nutrition science.

Dr. Robert Alpern, dean and the Ensign Professor at Yale School of Medicine, says of this gift:

PepsiCo’s commitment to improving health through proper nutrition is of great importance to the well-being of people in this country and throughout the world. We are delighted that they are expanding their research in this area and that they have chosen Yale as a partner for this endeavor.

You can’t satirize something like this, but why am I guessing that recipients of this fellowship are unlikely to study the effects of food marketing on obesity or the effects of fructose on metabolism or to advise their overweight patients to cut down on soft drinks? (Thanks to Michele Simon who commented on it on her newly restored blog, Sunday, March 7).

And then there is yesterday’s ugly story in the New York Times about Disney’s retaliation against the Center for Commercial-Free Childhood which had successfully gotten the company to back off on its advertising for Baby Einstein videos.  By all reports, Disney pressured the Harvard unit that housed the Center to evict the Center under truly shameful circumstances.

The moral: if you want to do something to prevent childhood and adult obesity, you are working against the economic interests of corporations that profit from kids eating too much food or watching too much television.  And you must take great care to hold on to your independence.

Thanks to Dr. Yoni Freedhoff for keeping me current on Canadian food politics. His latest post is about the Canadian Heart and Stroke Foundation’s new program to heart-check fast food meals.  The Foundation hasn’t officially announced the program yet, although you can  find it buried in an obscure questionnaire on its website.  Pizza Hut also mentions its participation in the program on its website.   [Update February 3: Pizza Hut has now announced its participation in the program]

The program is coming soon and here’s Dr. Freedhoff’s political cartoon of what it is likely to look like .  No, this isn’t real.  Dr. Freedhoff’s point is that it could be.

What, you might ask, are the criteria for the heart check?  Let’s just try sodium: 720 mg per serving.   Even the late and not lamented Smart Choices program did better than that (480 mg per serving).

You think Dr. Freedhoff is exaggerating and this is improbable?  Alas, not so.  In Australia a couple of years ago, I took this snapshot at a McDonald’s on the Adelaide beach.

The check marks come from the Heart-Tick program of the National Heart Foundation of Australia.  So Canada is just now catching up.  Canadian readers: can’t you do something about this?  And American Heart Association: clean up your act too!

Addendum: Thanks to Lisa Sutherland for pointing out that what gets heart-checked in Canada is comparatively low in U.S. terms.  She sends McDonald’s nutrition information as proof.   Practically everything is higher in sodium than 720 mg.  When it comes to sodium, everything is relative, I guess, but all of it is way high.

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.

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:

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.

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

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?”

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.

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.