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Follow the research money: why some doctors betray patients’ trust on diet

You expect Big Food to spin you a story that has nothing to do with  truth about the health benefits – or lack thereof – of its products. It is in the business of making profits, not making you healthy. You don’t expect doctors to collude with Big Food in spinning  yarns. Yet that’s what many medical doctors often do by accepting sponsorship from Big Food for research. Among experts who have documented the results of the medical profession’s cosy relationships with the food industry is Dr Marion Nestle, professor of nutrition, food studies, and public health at New York University. One of her most well-known quotes on the subject is that ‘sponsorship perverts science’.  

And in 2013, WHO Director General Margaret Chan said the food and drink industry’s involvement in public health policy was ‘dangerous’ and urged governments to put public health before business.  Little has changed. Here, Canadian nephrologist Dr Jason Fung takes an even more devastating look at how doctors, whether by default or design, have betrayed their patients’  trust. In doing so, Fung says, doctors have helped to make sponsorship and research into an ‘insidious form of advertising’. Once again, it’s a case of ‘follow the money’, and it doesn’t just apply to doctors in north America, but across the globe. – Marika Sboros

By Jason Fung*

doctors, money, researchA clip (British interventional cardiologist) Dr Aseem Malhotra showed at the recent low-carb, high-fat summit in Cape Town, reminded me of one of the great truths of our time:  you cannot be betrayed by those whom you do not trust.

While we often blame Big Food for obesity, we never really trusted them, so cannot really be betrayed.

But we have been betrayed.  By whom?  The story is even worse then you suspect.

Big Food wants to make more money. That’s no secret.  They have created an entirely new category of food, called “snack food”, and promoted it relentlessly. They advertise on TV, print, radio and Internet.

But there is an even more insidious form of advertising called sponsorship and research. Big Food sponsors large organisations such as the US Academy of Nutrition and Dietetics. Coca Cola General Mills, Kellogg Company and Pepsi are found among its “Premier” sponsors. At its annual meeting, a sponsor could hold “nutritional symposia”.

Coca Cola spreading the message

Coca Cola nutrition researchIn 2014, for example, the Coca Cola Company would teach dieticians about “Coaching Your Clients Toward Lasting Weight Loss”. The $50,000 Gold Sponsorship allowed the company to spread the message that sugar is not harmful to children. Thanks, Coca Cola.

Michele Simon, in her scathing report And Now a Word from our Sponsors uncovers how corporate giants such as Coca Cola and McDonalds “educate” health professionals.

And don’t forget the medical associations.

Kellogg's, American Heart AssociationIn 1988, the American Heart Association (AHA) decided that it would be a good idea to start accepting cash to put its Heart Check symbol on foods of otherwise dubious nutritional quality. The Center for Science in the Public Interest estimates that in 2002, the AHA received over $2 million from this program alone.

Food companies paid $7,500 for one to nine products, but there was a volume discount for more than 25 products. Exclusive deals were, of course, more expensive. In 2009, such nutritional standouts as Cocoa Puffs and Frosted Mini-Wheats were still on the Heart Check list.

In the US, the 2013 Dallas Heart Walk organised by the AHA featured Frito-Lay as a prominent sponsor. The Heart and Stroke Foundation in Canada was no better. As noted on Dr Yoni Freedhoff’s weightymatters blog , a bottle of grape juice proudly bearing the Health Check contained 10 teaspoons of sugar. The fact that these food were pure sugar seemed not to bother anybody.

Key opinion leaders

The researchers and academic physicians were not to be ignored either. These were key opinion leaders in the medical community.

In 2013, the authors of a prominent article in the  New England Journal of Medicine entitled Myths, Presumptions and Facts about Obesity, write that  “Diets (ie, reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long-term”.

Funny. How can a diet be effective, but generally not work? Isn’t that the very definition of ineffective?

Also, the authors declare plainly that doctors should not even recommend diets. Forget about eating a whole, unrefined, natural foods diet, reducing added sugars and refined starches such as white bread. Instead, the recommended treatments for obesity included meal replacement bars/ shakes, drugs and surgery. That’s certainly odd. Obesity is a dietary disease and requires a dietary cure. Instead, the authors favour meal replacements – among the last things I would ever recommend.

Ensure Plus, meal replacement shakeConsider the ingredient list of a popular meal replacement shake, Ensure Plus. This is the sort of “food” the study authors feel is highly beneficial to you. It also happens to be a highly profitable item. The first five ingredients are: water, corn maltodextrin, sugar, milk protein concentrate, canola oil. This nauseating blend of water, sugar and canola oil does not meet my definition of healthy.

Financial disclosures

So why would the study authors strenuously recommend this garbage? Things become a little clearer when you read the financial disclosures:

One of the authors reports receiving payment for: board membership from Kraft Foods;  consulting fees from Vivus, Ulmer and Berne, Paul, Weiss, Rifkind, Wharton, Garrison, Chandler Chicco, Arena Pharmaceuticals, Pfizer, National Cattlemen’s Association, Mead Johnson Nutrition, Frontiers Foundation, Orexigen Therapeutics, and Jason Pharmaceuticals;  lecture fees from Porter Novelli and the Almond Board of California;   manuscript preparation from Vivus;  travel reimbursement from International Life Sciences Institute of North America;  other support from the United Soybean Board and the Northarvest Bean Growers Association;  grant support through his institution from Wrigley, Kraft Foods, Coca-Cola, Vivus, Jason Pharmaceuticals, Aetna Foundation, and McNeil Nutritionals; and other funding through his institution from the Coca-Cola Foundation, Coca-Cola, PepsiCo, Red Bull, World Sugar Research Organisation, Archer Daniels Midland, Mars, Eli Lilly and Company, and Merck.

Clearly, that author was not going to bite the hand that fed him. That he should be allowed to write in such an influential journal is criminal. This is far from an isolated case.

In a 2012 Annals of Internal Medicine paper researchers write a spirited defense of fructose. They passionately argue that there is nothing wrong with fructose. The good name of fructose is unfairly being slandered. Reviewing all the available literature, they acknowledge that the vast majority of the data were poor. However, this does not stop them from boldly concluding that, “Fructose does not seem to cause weight gain when it is substituted for other carbohydrates in diets providing similar calories.”

This is odd. In nutrition science, virtually the only universally agreed-upon fact is that excessive fructose intake is  bad. Yet researchers argued the exact opposite. Things become clearer after reading the financial disclosures of one of the authors:

Grant (money to institution): Canadian Institutes of Health Research, Calorie Control Council; Support for travel to meetings for the study or other purposes: The Coca-Cola Company; Consultancy: Abbott Laboratories, International Life Sciences Institute (ILSI) North America, Archer Daniels Midland; Grants/grants pending (money to institution): The Coca-Cola Company; Travel/accommodations/meeting expenses unrelated to activities listed (money to institution): The Coca-Cola Company, Pulse Canada, Canadian Diabetes Association; Other: Director of BDSK Consulting.

 Greedy institutions

The author was receiving money from, among others, Coca Cola, Archer Daniels Midland (a huge corn grower) and the Calorie Control Council – a food industry association. The Coca Cola Company was funneling rivers of cash, not only to the doctor, but also to his greedy institution, St Michaels Hospital in Toronto.

The doctor, the hospital, and the university were all on the take.

Providing unbiased, helpful dietary advice is obviously not the top priority here. The common sense approach of reducing added sugars for weight loss needed to be discredited. The Coca Cola Company knew just the doctors to do it.

Funding sources have enormous implications on study results. In a study that looked specifically at soft drinks, the authors found that accepting funds from companies increased the likelihood of a favorable result by approximately 700%.

Fox guarding hen house

This finding is echoed in the work of Dr Marion Nestle, professor of nutrition at New York University. In a comment in the journal Public Health Nutrition in 2001, she found it “difficult to find studies that did not come to conclusions favoring the sponsor’s commercial interest.”

The fox was now guarding the hen house. A shill for Big Food had been allowed to infiltrate the hallowed halls of medicine. Influential doctors had scientifically prostituted themselves to the highest bidder. Push fructose? No problem. Push obesity drugs? No problem. Push artificial meal replacement shakes? No problem.

While doctors enjoyed their blood money, patients suffered the indignities of obesity and diabetes. Meanwhile, honest physicians read these highly circulated and respected journals. Trusting the “experts” within their pages, they would naively pass on these lies to their own patients.  While doctors, hospitals and research institutions counted their cash, patients went on dialysis, went blind, and had their feet chopped off from diabetes complications.

scapegoat
The scapegoat – calories

But the obesity epidemic couldn’t very well be ignored, and a culprit had to be found. “Calories” was the perfect scapegoat. Eat fewer calories, they said. But eat more of everything else. There is no company that sells “calories”. There is no brand called “Calories.” There is no food called “Calories”. Nameless and faceless, it was the ideal stooge. “Calories” could now take all the blame.

Who betrayed us?

They say that 100 calories of cola is just as likely as 100 calories of broccoli to make you fat. A calorie is a calorie. Don’t you know? But show me a single person that grew fat by eating too much steamed broccoli. I know it. You know it.

I am not angry at Big Food.  Their job is to sell food.  I am not angry at Fast Food.  Their job is to sell food.  They cannot betray us because we never trusted them.

Who betrayed us?  None other than our own medical associations, our own doctors.  We trusted these medical associations to have our best interests at heart.  They repaid us with the ultimate betrayal.

In the same way, Big Tobacco could never really betray us about the effects of smoking because we never trusted them.  But the doctors who supported Big Tobacco – they were the ultimate traitors to our profession.  We fight this battle again with the sugar pushers and the drug pushers.

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