In this interview, Nicholas Freudenberg, Director of the CUNY Urban Food Policy Institute asks Marion Nestle, Paulette Goddard Professor of nutrition, food studies, and public health, emerita, at New York University, and Visiting Professor of nutritional sciences at Cornell, about her new book Unsavory Truth, published by Basic Books in October 2018.
Nick Freudenberg: Your new book Unsavory Truth: How Food Companies Skew the Science of What We Eat examines how the food industry manipulates nutrition science. In the last decade or two, there have been renewed political attacks on science and scientists as a credible source of information: on climate change, gun violence, sexual and reproductive health and diet. In your opinion what’s the conversation the people of the United States need to be having about the role of science in our society between now and the 2020 election?
Marion Nestle: “Manipulates” isn’t quite the right word. The industry’s involvement in nutrition research is more subtle than that. But we certainly appear to be in an era of Orwellian doublespeak that discredits science in favor of personal experience or opinion—despite vast amounts of evidence for unconscious influences on what we feel or think. Those of us trained in science need to understand that concepts of probability and the lack of certainty in results make many people deeply uncomfortable. We need to acknowledge that discomfort in this discussion. For the sake of this discussion, let me just add that the research I did for this book adds up to three conclusions: (1) Industry-funded research almost invariably produces results that favor the sponsor’s marketing interests. (2) Recipients of industry funding are unconscious of the influence, do not intend to be influenced, do not recognize the influence, and typically deny it. (3) The influence largely occurs in design of the research question or in the interpretation of results. All of this makes conflicts of interest in nutrition research exceptionally difficult to deal with.
NF: Do you think that the conflicts of interest that food and beverage companies are now experiencing are worse or more serious than those of previous decades? Why or why not?
MN: It’s hard to know the trend without reliable data on how much nutrition research was and is funded by industry. I first wrote about industry funding of nutrition research and practice in 2001, but did not get back to it until 2015 when I wrote about Coca-Cola’s research funding in my book Soda Politics. I could see that other companies were also funding studies for what seemed like marketing purposes and started posting summaries on my blog, foodpolitics.com. It got so I could recognize them by their titles. Let me give one recent example: a study concluding that drinking beer can improve cognitive function in people with memory problems (funding by a beer manufacturer, of course). In one year, I had collected 168 industry-funded studies; 156 of them had results that favored the sponsor’s interest in this way. Aside from their predictable results, industry funding distorts the research question. I often get letters from food trade associations calling for proposals to demonstrate the benefits of their products. This is a very different question from asking how a product affects health. “Benefits” is to sell more products in a highly competitive marketplace; it’s not really about health.
NF: What do you think are the similarities and differences between how the food industry, the pharmaceutical industry and the tobacco industry manage conflicts of interest? Are these differences important?
MN: The food industry and nutrition researchers are way behind the pharmaceutical industry in recognizing the effects of industry funding and doing something about it. One reason is that the influence of drug companies is measurable. You can track how doctors’ prescriptions change after a visit from a drug detailer. And the Affordable Care Act required drug companies to publicly disclose who they pay, and how much (openpaymentsdata.cms.gov). The New England Journal of Medicine required authors to disclose who paid for their studies and their conflicted financial ties in 1984. Nutrition journals also did so, but much later. Medical professionals were complaining about drug industry influence in the 1970s and thousands of research studies have examined how this industry influences research and practice. I could only find 11 studies looking at the effects of food industry funding. We tend to think of food companies as benign providers of social service and to forget that they are businesses with stockholders to please. I think conflicts in nutrition research need more attention.
NF: As you have shown in this and previous books, nutrition sciences and big food companies have a long and intimate relationship. Despite these ties, at the heart of your work, I think, is the belief that nutrition science can and should play a more independent role in providing eaters and policy makers with accurate and useful evidence to make personal and policy decisions. In your view, what are some things nutritionists, nutrition professional organizations and students of nutrition and food can do to nurture this independence?
MN: The first step is to recognize that food industry funding exerts influence, and that because we may be unconscious of this influence, we had best take steps to prevent it. Right now, I don’t see many signs of this recognition. Instead, I hear a lot about how government funding for nutrition research is declining (true) and that industry funding does not affect the research design, conduct, and interpretation (false). Disclosure seems like a solution, but isn’t. The real solution is not to take the money, but that doesn’t seem possible or desirable to lots of people. At the very least, I hope my colleagues and students will recognize that a problem exists and set a policy to deal with it.
NF: What do you think universities can do, especially those involved in food research, to better avoid conflicts of interest as they pursue research funded by the food industry?
MN: I don’t think they should be pursuing research funded by the food industry. Industry-funded research is aimed at selling products, not basic science. Universities should be helping scientists find funding for investigator-initiated projects. Food companies won’t fund those unless they help with marketing. As I explain in Unsavory Truth, I can only think of one way that food companies can support research without exerting undue influence on its design or interpretation: a small mandatory tax on sales that gets pooled into a common fund distributed through an independent third party. Otherwise, the influence will exist and much evidence demonstrates that it is impossible to prevent (not least because so much of the influence occurs unconsciously). Politically feasible? Not a chance.
NF: In your public talks on Unsavory Truth, what are the most frequent questions readers ask you? When people disagree with your analysis, what are their common objections? How do you respond?
MN: By far the most frequent questions I hear are “how am I supposed to know whether research is reliable?” and “who can I trust?” To this last, my somewhat facetious answer is “me, of course.” But I understand where these questions are coming from. People feel bombarded with conflicting nutrition advice almost all of it framed as emanating from science. But basic dietary advice is so unchanging and so simple that the journalist Michael Pollan can summarize it in seven words: “Eat food. Not too much. Mostly plants.” That’s a good place to begin. Any time you hear the words “breakthrough,” “miracle,” “superfood,” or, my favorite, “everything you thought you knew about nutrition is wrong,” think red warning flag. That’s not how science works.
As for the objections: the main ones are “where else are we supposed to get research funding,” and “why are you picking on industry funding when career objectives and dietary ideology are just as biasing.” The decline or leveling off of government research funding is real and industry has been all too eager to fill the gap. I was appalled to read about the alcohol industry’s gift of $67 million to the NIH Foundation for a study of the effects of one drink a day on heart disease risk. The gift turned out to be conditional on the promise that the results would show benefits of alcohol, but no risks. NIH stopped the study but at great damage to its reputation for independence.
On the question of non-financial biases: everyone who does research has a hypothesis to prove, and everyone who does nutrition research has dietary preferences. These are common to all research, you can’t do research without them, and the study results will differ greatly according to variations in investigators’ biases. But industry-funded research is discretionary—it is not intrinsic to the research process—and its results predictably favor the sponsor’s interests. Big difference. I wrote this book to bring attention to these issues and to start a serious conversation about them.
NF: Thanks, Marion. Your book is already sparking this needed conversation. I hope every nutritionist, university administrator and food policy maker reads it.