Archive for July, 2010

Family doctors debate if they should take Coke money, after they took it

In this week’s Health Blog, the Wall Street Journal’s Katherine Hobson asks readers to chime in on a “debate” among family doctors over the ethics of corporate sponsorship of medicine.

But first, the backdrop. Last year, the American Academy of Family Physicians announced “a new corporate partnership program” and its first partner was to be The Coca-Cola Company. Soon thereafter, about 20 doctors resigned from the organization in protest, drawing attention to the matter by Food Politics author Marion Nestle as well as advocacy groups such as the Campaign for a Commercial-Free Childhood. (Full disclosure: I serve on CCFC’s steering committee.)

The grant amount was described as being in the “strong six figures” by AAFP. Here is how the group described the partnership in its October 2009 press release:

The Consumer Alliance is a program that allows corporate partners like The Coca-Cola Company to work with the AAFP to educate consumers about the role their products can play in a healthy, active lifestyle. As part of this partnership, The Coca-Cola Company is providing a grant to the AAFP to develop consumer education content on beverages and sweeteners for, an award-winning consumer health and wellness resource.

Consumer education? That must explain how a search for “Coca-Cola” on, brings up helpful content on hydration like how “even caffeinated drinks, such as coffee, tea and soda, count toward your daily water intake,” and why sports drinks are useful for athletes, and how safe the artificial sweeteners aspartame and saccharine are. All of this brought to you by Coca-Cola under the guise of consumer education. Even the disclaimers on each of these pages is misleading:

This content was developed with general underwriting support from The Coca-Cola Company.

That makes it sound as if the Coca-Cola is just paying someone else to do the writing. But it appears the company is directing the substance of the content as well, since the verbiage is pretty similar to that found on Coca-Cola’s own website on these very topics. (See for example, the company’s page on sweetener “facts and myths.)

It’s bad enough for a medical trade organization (and “award-winning” website) to be bought off by American’s number one promoter of unhealthy beverages, especially to children, but now apparently, almost a year later, the issue has turned into fertile ground for navel gazing as a way of justifying the move after the fact.

This week, AAFP’s journal, the Annals of Family Medicine, has published two perspectives on the matter. One penned by Dr. Howard Brody, AAFP member and director of the Institute for the Medical Humanities at the University of Texas Medical Branch. He’s not in favor of the idea:

The physician has a duty to prescribe medications or make dietary recommendations based on scientific evidence. The companies have an interest in selling more beverages, or more drugs, regardless of the evidence.

Precisely. In contrast, AAFP president, Dr. Lori Heim, sees no need to assume conflict of interest:

To gauge an individual or organization’s ethics, one must view its behavior over time, define the goal of that behavior and compare the outcome with the mission and values. Within this context, one can determine whether the assumption or appearance of conflict of interest or ethical lapse was, in fact, correct.

What? She lost me somewhere between outcome and values.

Taking money from Coca-Cola is not a science experiment that you watch over time, gather data, and then publish the analyzed results. But if one were to approach the issue that way, there’s no shortage of evidence of Coca-Cola’s “ethical lapses.” Whether your concern is marketing to children, labor abuses, or contaminating water supplies in developing nations, Coca-Cola would be the one company you’d not choose as a partner. Journalist Michael Blanding has written an entire book called The Coke Machine: The Dirty Truth Behind the World’s Favorite Soft Drink, due out in September, which chronicles these misdeeds and more.

But why, almost a year later, is the AAFP journal publishing what amounts to an academic debate between two doctors over an issue that has obviously already been decided? I realize that wheels of academic publishing turn very slowly and that perhaps these articles were submitted months ago, but why was there no public debate before AAFP took the money?

All this does now is give credence to idea that taking corporate money is a worthy subject of debate in the annals of medical journals, right up there with questions like, what sort of treatment a doctor should give patient X or Y. What about those 20 member doctors who resigned in protest last year? Where are their opinions published in any medical journal? This no debate at all. It’s simply an effort to whitewash the situation so now AAFP can say: See, we grappled with the issue in our journal under the heading “Ethical Issues.” Oh and by the way, we’re keeping Coke’s cash.

As I blogged about in March, Coca-Cola isn’t the only soda company seeking to infiltrate the medical establishment. The Yale School of Medicine has partnered with PepsiCo to allow the soft drink and snack food giant to fund a research lab and fellowship. Where does this end? At what point will we no longer have truly science-driven research institutions and unfettered medical professionals available to help Americans sort through the confusing clutter of health and nutrition information? Or has that time already come? Let’s hope not.

You can send a letter to AAFP asking them to end the Coke deal here, on the Campaign for a Commercial-Free Childhood’s website.

Nestle Stoops to New Low, Launches Barge to Peddle Junk Food on the Amazon River to Brazil’s Poor – AlterNet article

After previously blogging about the Nestle junk food barge, AlterNet asked me to write an article on the topic. How could I say no? Please read the expanded version of this story, this time with plenty of quotes, including an NGO in Brazil working to stop this very sort of marketing.

Happy Meal Lawsuit Update: Is McDonald’s Playing Games with Nutrition Facts?

Last week I blogged about how the Center for Public Interest (CSPI) is threatening a lawsuit against McDonald’s for using toys to promote Happy Meals to kids. Since then, McDonald’s has responded, sort of. In a letter apparently fed to the press even before CSPI got to see it, McDonald’s CEO Jim Skinner attempts to “set the record straight:”

We have a long history of working with responsible NGOs who are interested in serious dialogue and meaningful engagement; and we are open to constructive feedback.

Really? Like how McDonald’s worked with those two activists in the UK by suing them for libel in the 1990s for putting out a simple brochure? The case (dubbed McLibel) spawned a book and a movie and became notorious for being the longest English trial ever, not to mention the stupidest public relations move short of New Coke.

Skinner continues to dig his own grave:

Ronald McDonald also serves as an ambassador for children’s well-being, promoting messages around physical activity and living a balanced, active lifestyle.

Right. That must explain why an entire campaign was launched in March by Corporate Accountability International to Retire Ronald based on an investigation that showed how the clown’s main job is to promote McDonald’s unhealthy foods, in schools and just about anywhere children can be found.

And finally, Skinner asserts the company has “more choice and variety than ever before” in Happy Meals, and:

Furthermore, McDonald’s makes available in-depth, comprehensive nutrition information about our food to give parents the support they need to make appropriate choices for their children.

OK, now this is kind of true, and is where things get interesting. It appears that McDonald’s has already changed the nutrition facts on its website for Happy Meals. But only some Happy Meals, the ones that come with “Apple Dippers,” the healthy alternative to French fries.

In its June 22 press release about the potential lawsuit, CSPI complained that:

Of the 24 possible Happy Meal combinations that McDonald’s describes on its website, all exceed 430 calories (430 is one-third of the 1,300- calorie recommended daily intake for children 4 to 8 years old).

In documents provided by CSPI, here is what the nutrition listing looked like on the McDonald’s website as of June 15. If you compare these figures to this listing, which says is effective as of June 25, just 3 days after CSPI’s news release about the lawsuit, you will see for each of the Happy Meals that come with Apple Dippers, the number of calories has been reduced by exactly 70.

Could that be because McDonald’s has decided not to include the caramel dipping sauce in the total? Who knows? Any clever nutritionists out there want to help?

Not that this re-do really helps McDonald’s all that much, given that it only makes three of the 12 Happy Meal combinations with Apple Dippers below the 430 calorie level that CSPI says should be the cut-off. (And of course, all the others are still way over 430.) Never mind, CEO Jim Skinner has a retort to CSPI on that too:

On this point, it seems that you purposefully skewed your evaluation of our Happy Meals by putting them in the context of a highly conservative 1,300 calorie per day requirement. I’m sure you know this category generally applies to the youngest and most sedentary children.

The youngest? Ages 4-8 seems to fit squarely into McDonald’s Happy Meal demographic. The most sedentary? So now McDonald’s is saying as long as kids hop on the treadmill, Happy Meals full of chicken nuggets, fries, and soda is A-OK? You won’t find a health professional (not on Big Food’s payroll) to go along with that idea.

Also, as CSPI also pointed out, in 2007, McDonald’s pledged not to advertise to children meals that have more than 600 calories, and even with the revised calorie listings, 4 of the 24 combinations are still in violation of that pledge. Whatever the calories, it appears McDonald’s is headed to court. Here is Steve Gardner, CSPI’s litigation director, in response to the McDonald’s letter:

We’re encouraged to read that McDonald’s is signaling a willingness to make changes that are in the best interests of its customers. We hope that McDonald’s takes us up on our offer to negotiate an end to the practice of using toys to market unhealthful foods directly to children. If it doesn’t, that will all but guarantee that we will have to resort to litigation.

Stay tuned.

Update: Reporter Melanie Warner called McDonald’s to get an explanation for the calorie change. A spokesperson claimed they were just correcting a mistake. You can read her take at BNET.

McDonald’s Facing Potential Lawsuit for Luring Kids With Happy Meal Toys – It’s About Time

It was only a matter of time. Last month, the Center for Science in the Public Interest (CSPI) served McDonald’s with a notice of its intent to sue if the fast food giant continues to use toys to promote Happy Meals. (An “intent to sue” letter is a prerequisite to filing a lawsuit in some states.) The basis for the potential case is that using toys to market to small children is unfair and deceptive under the consumer protection laws in a number of states. According to CSPI’s letter, McDonald’s toy promotions violate the laws of California, Massachusetts, New Jersey, Texas, and the District of Columbia. 
CSPI’s litigation director Stephen Gardner explained in a statement that “McDonald’s is the stranger in the playground handing out candy to our children. McDonald’s use of toys undercuts parental authority and exploits young children’s developmental immaturity.”
The letter more specifically spells out the legal basis for the case:

McDonald’s practices are predatory and wrong. They are also illegal, because marketing to kids under eight is (1) inherently deceptive, because young kids are not developmentally advanced enough to understand the persuasive intent of marketing; and (2) unfair to parents, because marketing to children undermines parental authority and interferes with their ability to raise healthy children.

This is important because CSPI is saying that McDonald’s practices are both deceptive to children and unfair to parents, the latter to deflect the argument that it’s really all the parents’ fault. For that perspective, CSPI’s press release quotes Sheila Nesbitt of Minnesota, a parent of a six-year-old boy and a three-year-old girl:

McDonald’s makes my job as a parent more difficult. They market cheap toys that appeal to kids and it works. My kids always want to go to McDonald’s because of the toys. I try my best to educate my kids about healthy eating but it’s hard when I am competing against the allure of a new Shrek toy.

According to a CSPI study, despite McDonald’s recent attempts at healthwashing Happy Meals with Apple Dippers and milk, French fries come with Happy Meals 93 percent of the time. The letter also explains the harm that Happy Meals cause:

McDonald’s practice of dangling toys in front of children is illegal, regardless of what meal the child eventually gets. Not only does the practice mobilize “pester power,” but it also imprints on developing minds brand loyalty for McDonald’s. Because most of the company’s options are of poor nutritional quality, eating Happy Meals promotes eating habits that are virtually assured to undermine children’s health.

Next, the letter explains how voluntary, self-regulation by industry has been a dismal failure:

Through the Children’s Food and Beverage Advertising Initiative of the Council of Better Business Bureaus, McDonald’s pledged to advertise only Happy Meals that meet McDonald’s nutrition standards for children. However, that pledge fails to address McDonald’s insidious use of toys to market its products to children. Regardless of the Happy Meal combinations shown in advertising, the vast majority of possible Happy Meals are nutritionally inappropriate for children.

This is important because (as documented in my book, Appetite for Profit) McDonald’s, along with every other major food company, has been hiding behind the veil of self-regulation of marketing to children for years. And sadly, the federal government has so far been going along with the charade. This lawsuit could become one way to expose this ruse, and even lay the groundwork for changing the laws to protect children. Because companies fear lawsuits even more than they fear regulation, the case could be a game-changer.

McDonald’s response in the press has been to defend the Happy Meal, not surprisingly. William Whitman, vice president of communications for McDonald’s USA, told Nation’s Restaurant News: “We are proud of our Happy Meal, which gives our customers wholesome food and toys of the highest quality and safety. Getting a toy is just one part of a fun, family experience at McDonald’s.”
It’s all fun until someone gets hurt. Chicken McNuggets are wholesome? Here are the ingredients, as listed on McDonald’s own website:  
White boneless chicken, water, food starch-modified, salt, seasoning (autolyzed yeast extract, salt, wheat starch, natural flavoring (botanical source), safflower oil, dextrose, citric acid, rosemary), sodium phosphates, seasoning (canola oil, mono- and diglycerides, extractives of rosemary). Battered and breaded with: water, enriched flour (bleached wheat flour, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), yellow corn flour, food starch-modified, salt, leavening (baking soda, sodium acid pyrophosphate, sodium aluminum phosphate, monocalcium phosphate, calcium lactate), spices, wheat starch, whey, corn starch. Prepared in vegetable oil (Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness). Dimethylpolysiloxane added as an antifoaming agent.

That last ingredient sounds especially wholesome.

Toys of the highest quality and safety, like those toxic Shrek glasses?

As I wrote about here in April, the Santa Clara County, Calif., Board of Supervisors passed an ordinance to stop chain restaurants from using toys or other kid-oriented incentives to market unhealthy meals. This case is a logical next step and is certainly more efficient than going county by county to get fast food chains to halt this insidious practice. Of course, this case will only be about McDonald’s, for now. Other food chains (think Burger King) that don’t want to be next may be forced to re-think their kids marketing practices as well.

Of course, already the potential case is already being attacked by those who say it’s all up to parents. CSPI’s executive director Michael Jacobson responds to the parental argument this way: 

I’m sure that industry’s defenders will blame parents for not saying ‘no’ to their children. Parents do bear much of the responsibility, but multi-billion-dollar corporations make parents’ job nearly impossible by giving away toys and bombarding kids with slick advertising.

So will this case mean the end of all toys in Happy Meals or will CSPI settle for McDonald’s setting nutrition standards on those meals the company markets with toys? CSPI’s not saying, but Michael Jacobson did say in the press release that “regardless of the nutritional quality of what’s being sold, the practice of tempting kids with toys is inherently deceptive.” I couldn’t agree more. 
McDonald’s has 30 days (from June 22) to stop marketing with toys before a case is filed. I asked Steve Gardner today if he’s heard back from McDonald’s yet and here’s what he said: 
We’ve gotten an acknowledgment from McDonald’s that they got the letter, but no response to the suggestion that we discuss before suit is filed. One thing is certain: if McDonald’s chooses not to negotiate, we will sue.

And that’s when things will get interesting. For those who think lawsuits are too extreme, consider this: We have only three branches of government, and two have been failing us for too long. The executive branch, even with Obama at the helm, has shown little interest in fixing the problem of junk food marketing to children. And the legislative branch (aka Congress) has been bought out by corporate interests for decades. That leaves only the judicial branch, which is why this case make sense, and why it was only a matter of time until someone sued over this issue.

Meantime, you can take action by sending an email message to McDonald’s CEO Jim Skinner asking the company to stop marketing toys to kids. You can also join a related campaign by Corporate Accountability International asking McDonald’s to Retire Ronald.

How Did PepsiCo’s CEO Infiltrate the Robert Wood Johnson Foundation’s Annual Report on Obesity?

Because I tend to focus my attention on news being generated by the major food companies, I don’t always pay close attention to the latest scary reports on obesity data. So when the annual report called F as in Fat: How Obesity Policies are Failing America came out this week, I just thought, Oh there’s that report again with the awful name, with the same gloomy numbers as last year.

But then I got an interesting email message forwarded from New York University professor and food politics maven Marion Nestle that made me realize I should pay closer attention to this year’s report. The email was from Harold Goldstein, executive director of the highly effective non-profit, California Center for Public Health Advocacy. He was questioning how the CEO of PepsiCo was given 2 pages of airtime in the report. What was that? The CEO of a major company contributing to the very facts and figures contained within the 124-page document was offered space to make her case?

Under the heading, “A Personal Perspective,” here is just a sampling of what PepsiCo CEO Indra Nooyi had to say: (her entire missive is on pages 44-5 of the report)

At the heart of America’s obesity epidemic us achieving a balance between the calories we put into our bodies and the calories we burn. It’s a simple equation but a complex challenge that companies must help their employees and consumers to overcome….
We firmly believe companies have a responsibility to provide consumers with more information and more choices so they can make better decisions… I believe the food industry can play a leading role in this area. In fact, we must play a leading role… It’s a challenge, but increasingly PepsiCo and other companies recognize and accept our responsibility to help our associates and consumers succeed.

OK, so this rhetoric is certainly nothing new and on its own reads like the usual PR-speak that we’ve come to expect from the likes of the maker of Cheetos and Mountain Dew. But let’s place these remarks into context. This report, which has been published annually for the past seven years, is put out by the organization, Trust for America’s Health (TFAH) a fairly well-known public health nonprofit based in Washington, DC. Obesity is one of  TFAH’s several issue areas and they describe themselves as a “non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.” Noble enough.

This report gets a lot of press each year and is especially popular for how it ranks each state according to its obesity statistics. It also provides federal and state policy progress in a variety of areas, is fairly comprehensive, and relies heavily on government sources. In other words, the document makes a major contribution to the national conversation regarding obesity prevention and public policy.

Moreover, the report is co-published by its funder, the Robert Wood Johnson Foundation (RWJF) the nation’s largest healthcare foundation. One of RWJF’s most ambitious goals is to “reverse the childhood obesity epidemic by 2015.” Since 2007, the foundation has backed that up with an impressive $500 million in grants to myriad programs around the nation. These days, it’s hard to run into a childhood obesity prevention program that isn’t funded by RWJF.

So how did the nation’s largest healthcare funder and a prominent public health organization let the nation’s largest food company get airtime in their annual obesity report? Good question.

In the introduction to the report is this attempted explanation: “TFAH asked the following policy-makers and experts in the field of obesity to offer their perspectives on what needs to be done to address the obesity crisis in the United States.” And then PepsiCo CEO Indra Nooyi is listed among other contributors including Senator Tom Harkin and Kelly Brownell, director of Yale’s Rudd Center on Food Policy and Obesity. That’s quite a coup, for CEO Nooyi to be listed among the very same experts who are fighting PepsiCo’s lobbying efforts. 

Reporter Melanie Warner, who just published an excellent piece about this at BNET, (Obesity Report Chronicles the Sad State of America — and Tells Us How Great PepsiCo Is) asked TFAH to explain itself. Here is what she learned:

Laura Segal, spokesperson for the Trust for America’s Health, says that having Nooyi’s comments in the report was an innocent attempt to have the “industry perspective” and not the result of any shady financial relationship. “We reached out to a number of companies and Pepsi was the first one to respond. We want to represent a range of opinions and the industry segment is a significant component of dealing with obesity,” says Segal.

Harold Goldstein (who gets the credit for first sounding the alarm) sees this incident as part of a troubling trend: 

There seems to be a growing interest among public health organizations to appear “unbiased” when discussing obesity prevention by providing a forum for industry. It would be the equivalent of providing a forum for the tobacco industry to espouse their “personal responsibility” message in reports on smoking-related deaths.

As a national public health organization, I would have hoped TFAH would provide a clear and scientifically based public health perspective on issues like personal responsibility, rather than simply providing a forum for dissenting perspectives. 

Also, the placement of the PepsiCo text is either suspect or ironic. It comes right after two pages describing recent efforts by various states to enact soda taxes, a contentious issue that PepsiCo lobbies hard against, despite mounting evidence that it may be one of the most effective policies available. Recognizing the connection, Harold Goldstein describes what Nooyi left out of her statement:

She doesn’t mention the highly sophisticated multimillion dollar national marketing and lobbying campaign they have undertaken to promote themselves as good corporate citizens and undermine efforts to establish state and local policies to reduce consumption of sugar sweetened beverages, which have been the single leading contributor to the obesity epidemic. 

 It’s bad enough when the government invites industry executives to “workshops” on food marketing, and for years we have seen corporate sponsorships of nonprofits such as the American Heart Association and the American Dietetic Association. But this hurts even more, because it was unexpected. If we can’t even read a major public health report on obesity data and policy solutions without running into a PR statement by Big Food, then no place is safe.

As Melanie Warner points out: “the inclusion of Nooyi’s remarks in a public health report feels a bit like if Congress were to suddenly decide to give BP several pages with which to defend itself in forthcoming congressional reports on the oil spill.”

While most of the information contained within the report may still be reliable, the fact that PepsiCo was allowed to participate also raises the question, what other editorial decisions were made that might have been favorable to the food industry? We’ll never know, and that’s the heart of the problem: Once the door is open to providing industry a forum in a public health context, no longer can we trust that we are getting the best information available from those sources.

Finally, I asked Marion Nestle for her reaction:

By this time, research has clearly demonstrated that partnerships and alliances of health organizations with food companies benefits the food companies far more than the health organizations.  The goals of public health and food companies differ. Food companies enter such alliances for public relations and to deflect public attention from the need to regulate their marketing practices. RWJF ought to be well aware of the risk of such alliances and to protect its integrity against them.

What do you think? It would be great to hear from RWJF grantees. You can make comments on this blog anonymously if you prefer.

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