Unsavory Truth

1

The Food Industry and Nutrition

I LOVE NUTRITION SCIENCE. ON MY FIRST TEACHING JOB, I WAS assigned to teach a nutrition course and it was like falling in love. To this day, I love the intellectual challenge of figuring out what we eat, why we eat what we do, and how diets affect our health. It is not easy to study these questions in the context of everything else that influences health, not least our genetics, cultural upbringing, lifestyle, income, and education. I am also endlessly fascinated by the way food choices relate to so many of the most challenging problems in society—health is only the most obvious. What we eat is linked to matters of poverty, inequality, race and class, immigration, social and political conflict, environmental degradation, climate change, and much else. Food is a lens through which to examine all those concerns. I love the complexity of food issues and the passion people bring to every one of them. But I do not love the way the food industry has added an unnecessary complication: engaging nutrition professionals in marketing objectives, sometimes against the interests of public health.

Unsavory Truth is about how food, beverage, and supplement companies (collectively, food companies) fund nutrition researchers and practitioners and their professional associations, with the ultimate goal of promoting sales. This book appears at a time when scandals created by such funding make front-page news. Let me plunge right in with an unexpected—and highly surreal—example of why the topics in this book should matter to all of us.

You may recall that during the especially contentious US presidential race of 2016, hackers linked to the Russian government stole a trove of electronic messages from Democratic Party officials and posted them on the WikiLeaks website. They also stole emails from people working on Hillary Clinton’s campaign and posted them on a new website, DC Leaks. International intrigue like this ought to seem light-years removed from food-industry funding of nutrition professionals except for one truly bizarre coincidence: the cache on DC Leaks included messages exchanged between an adviser to the Clinton campaign, Capricia Marshall, and Michael Goltzman, a vice president of the Coca-Cola Company. While working with Clinton, Marshall was also consulting for Coca-Cola and billing the company $7,000 a month for her services.¹

The Coca-Cola emails may have been collateral damage from Russian interference in the American election, but to me they were a gift. They bear directly on the major themes of this book, not least because I turn up in them. The hacked emails included a January 2016 message from the director of an Australian agency doing public relations for Coca-Cola with notes taken at a lecture I had just presented to the Sydney chapter of the Nutrition Society of Australia. I was then a visiting scholar at the University of Sydney affiliated with the bias-in-research group of Professor Lisa Bero, whose studies of corporate influence on research appear frequently in this book. The emailed notes on my lecture—quite nicely done, actually—name some of the people attending my talk, review its content, and advise Coca-Cola to monitor my future presentations, research, and presence on social media and also to keep tabs on Professor Bero’s work.²

I vaguely remember someone telling me that a representative from Coca-Cola was at my talk but thought nothing of it. My 2015 book about the soft-drink industry, Soda Politics: Taking on Big Soda (and Winning), had just been published, and I assumed that someone from that industry was in the audience at every talk I gave. The stolen emails demonstrate Coca-Cola’s intense interest in the activities of individuals anywhere in the world who might question the health effects of its products.

The emails also reveal this particular company’s pressures on reporters—and their editors—who write about such topics. In 2015, Candice Choi, a reporter for the Associated Press (AP), was investigating Coca-Cola’s recruitment of dietitians to promote sodas on social media. This company’s public relations staff had been working with dietitians for years to get them “to place sponsored content that promotes how our beverages can fit within a healthy, balanced diet.” Because the staff expected Choi’s article “to have a cynical, negative perspective,” they “reached out to the AP’s editors to formally register concerns about the story,” promising to “continue to urge them not to run with the story.”³ In this instance, the pressures did not succeed. As published, Choi’s article described the ways food companies worked “behind the scenes to cast their products in a positive light, often with the help of third parties who are seen as trusted authorities.” She quoted a company spokesman’s defense of this strategy: “We have a network of dietitians we work with.… Every big brand works with bloggers or has paid talent.”⁴ Really? Thanks to the emails, we now know something about how this system works.

The emails show how Coca-Cola operates to influence reporters who write about such topics. Coca-Cola staff were on a first-name basis with Mike Esterl, a reporter for the Wall Street Journal. They had learned about a study demonstrating the benefits of soda taxes and wanted to make sure that “Mike understood the source of the study and that it had not been published or peer reviewed yet.”⁵ Another message said, “FYI—please note we have been engaging Candice Choi AP reporter since April on this story and there have been numerous engagements—both verbal and written.”⁶

This same email also refers to the cozy relationship between Coca-Cola’s then chief scientific officer, Rhona Applebaum (whom we will also meet again), and university scientists conducting research funded by the company. Coca-Cola staff wrote that they had confirmation from Choi that her story would include an email exchange in which Applebaum referred to the group of university researchers she works with regularly as the “Cartel” and another in which Applebaum referred to critics of Coca-Cola as “trolls.” Choi’s published article (in which I am quoted) made two points: industry-funded research typically promotes the sponsor’s interests, and some researchers make a living doing research funded by food companies and trade associations. She noted that one such group “regularly delivered favorable conclusions for funders—or as they call them, clients.”⁷

Other messages referred to Coca-Cola’s lobbying to influence federal nutrition advice. The public relations team worried that the academic advisory committee responsible for reviewing the research for the 2015 Dietary Guidelines for Americans had proposed “eliminating sugar-sweetened beverages from schools, taxing them, and restricting advertising of foods and beverages with ‘high’ sodium or added sugars for all populations.” The public relations team suggested that the company “should be prepared for this report to be cited frequently by activists” and should “work together to balance coverage.”⁸ Coca-Cola’s director of government relations later assured colleagues that his team had been working closely with Congress and federal agencies “to ensure that policy recommendation on a soda tax is not included in the final guidelines.”⁹ These efforts succeeded; the word “tax” does not appear anywhere in the 2015 dietary guidelines.¹⁰

Overall, the hacked emails offer a rare glimpse into how this beverage company—simply in the normal course of doing business—attempted to influence nutritionists, nutrition research, journalists covering this research, and dietary advice to the public. Other food companies do this too when they can.¹¹ The difference? Coca-Cola got caught.

This was not the first time Coca-Cola got caught, and therein lies the genesis of this book. In August 2015, while Soda Politics was at the printer, the New York Times ran a front-page story on Coca-Cola’s funding of university researchers who had created a group called the Global Energy Balance Network (GEBN). The GEBN’s purpose was to convince the public—against much evidence to the contrary—that physical activity is superior to dieting (and to avoiding Coca-Cola, of course) as a means of controlling body weight.¹² Because I was quoted in that story, reporters called me for further comment. They could hardly believe that a company as prominent as Coca-Cola would fund research so obviously self-serving, that researchers at respected universities would accept funds from Coca-Cola for this purpose, or that universities would allow faculty to do so. It seemed clear that if reporters had no idea such practices existed, I had another book to write.

As it happened, I was ready to take this on. I wrote my first article about such matters in 2001.¹³ By August 2015, I was well into what turned out to be a year-long project to collect industry-funded studies that produced results favorable to the sponsor’s interests. In March 2015, I began to post summaries of such studies on the blog I have written since 2007 at my website FoodPolitics.com. I continued these postings until March 2016. I will get to the results of this exercise later on, but for now let me just summarize a couple of examples, the first from scientists associated with the GEBN.

Coca-Cola had given these investigators research grants to examine the effects of physical activity on energy balance and body fat. The GEBN scientists reported that the people they studied could balance calorie intake by taking just 7,116 steps per day, “an amount achievable by most adults.”¹⁴ This study may appear to be basic research on exercise physiology, but it implies that physical activity—and not all that much—is all you need to control your weight, regardless of how much Coca-Cola you drink.

Coca-Cola is by no means alone in sponsoring marketing research masquerading as basic science. Here is another example. Late in 2017, the Journal of the American Heart Association published the results of a clinical trial concluding that incorporating dark chocolate and almonds in your diet may reduce your risk of coronary heart disease.¹⁵ I love that. But can you guess who paid for this study? The Hershey Company and the Almond Board of California were its funders. They also paid seven of the nine authors for their participation; the other two were employees of the funders.

But what if the findings of such studies are true? If exercise, chocolate, and almonds are good for health, what is wrong with funding research to prove it? This is a serious question that deserves a serious answer. Hence: this book. Let me state for the record that financial ties with food companies are not necessarily corrupting; it is quite possible to do industry-funded research and retain independence and integrity. But food-company funding often does exert undue influence, and it invariably appears to do so. Even a hint of industry funding is all it takes to reduce trust among some segments of the public. Nutrition professionals have long recognized the reputational hazards of accepting sponsorship from food companies but for the most part have considered the benefits—in money, resources, and contacts—to be well worth the risk. From the food industry’s standpoint, “capturing” nutrition scientists and practitioners is a well-established strategy for influencing dietary advice and public policy.¹⁶

Food companies must believe they need such strategies to survive in today’s fiercely competitive marketplace. The US food supply provides about four thousand calories a day per capita (which includes everyone from tiny babies to sumo wrestlers), adding up to roughly twice average need. But Wall Street expects publicly traded corporations to do more than make profits; it expects them to increase shareholder value every quarter.¹⁷ Competition forces food companies to work hard to convince customers to buy their products rather than those of competitors, to eat more in general, and to choose products that are more profitable. But by far the most profitable products are highly processed “junk” foods and beverages, high in calories but low in nutritional value. Enlisting nutrition professionals to declare such products harmless makes good business sense. So does engaging them in promoting healthier foods as “superfoods,” a marketing term with no nutritional significance.

As a nutrition professor, I deal every day with people’s bafflement about food choices. In 2006, I wrote What to Eat in the hope of reducing some of the confusion and encouraging readers to enjoy food—one of life’s greatest pleasures. Basic dietary advice is so constant and simple that the journalist Michael Pollan can summarize it in seven words: “Eat food. Not too much. Mostly plants.”¹⁸ Advice like this, alas, does not sell food products. Influencing nutrition professionals does.

Much of what we know about corporate influence comes from studies of the tobacco, chemical, and pharmaceutical industries. Most relevant to the food industry is the way pharmaceutical companies induce physicians to prescribe more expensive and sometimes unnecessary brand-name drugs and commission research to demonstrate that their drugs are safer and more effective than generics or those of competitors. Decades ago, medical professionals recognized the distorted effects of drug-company practices, measured the distortions, and took steps to counter them. Medical journals required authors to disclose financial ties to drug companies that might profit from the results of their studies. Medical schools banned drug companies from marketing to students. In 2010, Congress required drug companies to disclose payments to physicians. Nothing close to that level of concern, scrutiny, or action applies to food-company efforts to engage nutrition professionals.¹⁹

Perhaps because food-industry practices are less easily measured, nutrition professionals have lagged in recognizing and dealing with the reputational and other hazards of such partnerships. Research on these hazards is relatively new, but the few studies that have been published suggest close parallels with drug-industry effects. Like drug-industry influence, food-industry influence is a systemic problem as well as a matter of personal ethics.²⁰ Food companies also distort research to focus on topics useful for product development or marketing, influence investigators to put favorable spins on equivocal results, and encourage nutrition professionals to offer favorable opinions about sponsors’ products or to remain silent about unfavorable effects. When nutrition professionals partner with food companies, they can appear to be more interested in promoting industry marketing objectives than in furthering public health.

Let me make clear that I do not find these issues easy to talk about. One reason is that the effects of industry funding seem to occur at an unconscious level, so much below the radar of conscious thought that the influence is not recognized. Another is that revealing financial relationships with food companies is so personally embarrassing that nobody wants to talk about them. My own situation illustrates these difficulties.

As should already be evident, I am in this story as well as writing about it, and I have my own issues dealing with food companies, professionally as well as personally. On the professional side, I work with colleagues who accept such funding and resent the slightest suggestion that doing so might influence their work. Journal editors seem leery of publishing pieces on industry-induced conflicts. I have had more than my share of publication difficulties writing about these topics: multiple rounds of peer review, rejection of commentaries I had been invited to submit, and, in one especially painful instance, a retraction.²¹

Yet I cannot easily avoid engaging with food, beverage, and supplement companies. They send me product samples. They sponsor the meetings I attend, the societies I belong to, and the journals I read. They send me newsletters, books, press materials, teaching materials, and gifts, both small (pens, squeeze toys, flashlights, jump drives) and large (would you believe a full-size punching bag resembling a can of soda?). I occasionally advise food companies or answer their questions, and I speak at meetings they sponsor. As I explained in my book Food Politics, these kinds of interactions are commonplace among academic nutritionists; it is only questioning them that is unusual.

As a nutrition professor, I need to know what food companies are doing, and I find interactions with them informative, if occasionally awkward. I was well along in writing this book when Daniel Lubetzky, the charismatic owner of the KIND fruit-and-nut snack-bar company, asked me to help select the board of his new nonprofit foundation, Feed the Truth (FTT). He had pledged $25 million over ten years to FTT to “improve public health by making truth, transparency and integrity the foremost values in today’s food system.”²² FTT would sponsor investigative research and education programs to expose food companies’ efforts to distort research and oppose public health efforts. I could not possibly refuse.

But the AP’s Choi, ever on the case, wrote about my role, “The irony of such a group being established by a snack bar CEO is not lost on Marion Nestle, a professor of food studies at New York University who is helping nominate the board. She said she usually keeps industry at arm’s length, but found Lubetzky ‘very persuasive’ and felt Feed the Truth could raise awareness about corporate influence in nutrition research.”²³ Choi’s article then noted that FTT had paid my travel expenses to a meeting in Washington, DC. Choi deserves high marks for asking about payments received, but I did not particularly relish having this reimbursement disclosed in the Washington Post.

Let me put that reimbursement in context. Over the years, I have had to develop a management policy for dealing with payments and gifts from food companies—what I can and cannot accept—to try to minimize their influence and to remind me to be vigilant about avoiding unconscious influence. Under this policy, I accept reimbursements for travel, lodging, and meal expenses, but I do not personally accept honoraria, consulting fees, or any other direct payments. Instead, I ask food companies to make an equivalent donation to the Marion Nestle Food Studies Collection at the New York University (NYU) library or, now that I am officially retired from NYU, to my department’s student-travel fund. If the payments come directly to me, I endorse the checks over to one or the other (and declare all of this on tax forms).

As we will see, much evidence demonstrates that payments for travel, hotel, meals, meeting registrations, and small gifts are all it takes to influence the research results and prescription practices of physicians.²⁴ I have no reason to think I am unusually immune from the influence of payments that go to a library collection or scholarship fund from which I derive reputational benefit. Imperfect as my policy may be, it requires me to think carefully about every interaction with a food company that involves payments or gifts.

Another example: in 2017, I was invited to speak at a scientific symposium in Switzerland organized by Nestlé (to which I am not related), a company long accused of evading or violating ethical and legal codes for marketing breast-milk substitutes and weaning foods.²⁵ I accepted because I was curious to learn more about the company’s science enterprise and wanted the opportunity to share my views with an audience to which I do not usually have access. But critics of Nestlé’s actions judged the risk of the company’s using me for its own ends and the damage to my reputation as so great that they urged me to refuse the invitation. Having the policy forced me to think long and hard about the potential consequences of my decision to speak at this symposium.

I am well aware that I am in an unusually fortuitous position to be able to hold such a policy, make such decisions, and write books about such topics. I have never had to depend on grant funding. During my three decades at NYU, I was privileged—and believe me, I know exactly how privileged—to hold a tenured, “hard-money” full professorship that paid my entire salary and provided a research stipend, telephone, computer, and first-class library, all I need for the kind of research I do.

In writing this book, I also faced one other difficult decision: what not to include. To limit its scope, I chose to focus on the consumption side of food-industry influence—the companies making foods and beverages that people typically eat. Even here, I chose to exclude several categories: alcoholic beverages, dietary supplements, and artificial sweeteners. The alcohol industry’s similarity to the tobacco industry in manipulating research and policy is already well established.²⁶

In Food Politics, I wrote extensively about the paucity of evidence for the value of dietary supplements for anyone who eats enough of a reasonably varied diet. The supplement industry funds many studies that demonstrate health benefits from taking one supplement or another, but studies funded independently usually do not—and sometimes suggest that taking nutrients in pill form can be harmful. Despite this evidence, half of American adults take supplements in the belief that they compensate for poor diets.²⁷ This industry is highly skilled at getting the research it needs to exploit anxieties about dietary inadequacy. Caveat emptor.

As for artificial sweeteners, the companies that make and use them often fund studies to prove that these substances, singly and together, are safe and effective for weight loss, but research funded by nonindustry sources questions such results.²⁸ While waiting for further studies to determine the safety or efficacy of these chemicals, I follow a personal food rule: never eat anything artificial.

Furthermore, to keep this book from being twice its current length, it will say nothing or little about companies involved in production agriculture—genetically modified foods, agrochemicals, or organic foods. The efforts of these industries to influence research, opinion, and policy also have been thoroughly investigated and documented.²⁹ But even without these deliberate omissions, we still have plenty to talk about.

Unsavory Truth is about the conflicts of interest induced by food-industry interactions with nutrition professionals and the systemic effects of those conflicts on public policy and public health. For our purposes, such conflicts can occur when researchers or nutritionists whose primary interest is to produce new science or offer advice about nutrition and health end up distorting—or appearing to distort—their findings or opinions as a result of their financial ties to food companies.

In public health terms, industry-induced conflicts constitute a “wicked” problem, one with no easy solution beyond not taking the money.³⁰ But in the real world of nutrition research and practice, not taking the money is easier said than done, especially by those who are more dependent than I am on external funding for their research and salaries. Even so, I think it would be healthier for all of us if nutrition professionals—practitioners as well as researchers—grappled much harder with the risks and consequences of food-company sponsorship and set firm policies to minimize these problems.

But what about you? The real question here is how you—as a reader, eater, and citizen—can recognize and protect yourself against the onslaught of misleading information and advice that results from food-company manipulation of nutrition research and practice. Everyone eats. Food matters. All of us need and deserve sound nutrition advice aimed at promoting public health—not corporate commercial interests. How do we make that happen? Read on.