When the search for truth is confused with political advocacy, the pursuit of knowledge is reduced to the quest for power.
—ALSTON CHASE
When we make a list of “good guys” in the area of health, surely that list is topped by those selfless societies dedicated to defeating disease and spreading the gospel of good health practices. I’m referring, of course, to patient advocacy and fundraising groups such as the American Cancer Society (ACS) and the National Multiple Sclerosis Society (MS Society), which raise money and awareness in service of cures for very serious diseases, as well as professional organizations such as the American Society for Nutrition (ASN) and the Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association, until January 2012), which provide the education, networking, and leadership opportunities their professional members need to be as effective at their jobs as possible. But their donations and PR, their awards and fundraisers, just reinforce the system in which they are embedded—a system that lauds reductionist research and ignores nutrition.
The sad fact is that too many of these organizations are more likely to be found shilling for pharmaceutical companies and the food industry than advocating for patients or sharing scientific truths. And because these wolves clothe themselves in a sheepskin of selfless service, they are exceptionally good at pulling the wool over our eyes.
Patient advocacy groups like ACS and the MS Society ostensibly exist to eradicate specific diseases. The MS Society, according to its website, “helps people affected by MS by funding cutting-edge research, driving change through advocacy, facilitating professional education, and providing programs and services that help people with MS and their families move their lives forward.”1 Replace “MS” with “cancer” or “diabetes” or “heart” or any number of diseases or parts of the body and you’ll essentially have the mission statement of every such advocacy group. Professional medical societies have a similar goal; the main difference is their focus on a specific medical discipline, rather than on the particular disease or diseases that discipline treats. The AND, for example, “is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.”2 Both types of organization are as concerned with power and influence as they are with treatment and cure; the goal of most disease societies is to set themselves up as the “official” body that sets national policy on their disease, and professional societies typically seek the power to set standards and criteria for membership in their profession.
These organizations see their gatekeeper roles as very important for protecting the public from fraud and incompetence, but this gatekeeping can just as easily stifle innovative approaches and fresh paradigms. Viewed cynically, these organizations begin to look like monopolies seeking to maintain their power at the expense of those who would challenge their worldview. At the heart of every disease society and professional organization is an assumption about who is a legitimate practitioner and who is a “quack.” These assumptions are generally unspoken until a challenger arises with a treatment protocol or research agenda that contradicts prevailing wisdom—and the prevailing wisdom in these organizations, as it is elsewhere in our health-care system, is the reductionist paradigm. As a result, despite the sincere efforts of many well-meaning people, these organizations actually get in the way of the treatment and cure of the very conditions they demonize in their PR and fundraising.
INDUSTRY DOLLARS AT WORK
In a healthy system, these organizations, especially the nonprofit ones, would be independent, beholden only to their members and the patients they serve. However, the main source of funding that supports these organizations is, as with the other groups we’ve looked at these last few chapters, the pharmaceutical and medical industries.
These organizations depend on industry in several ways. Most are funded largely by corporate donations, and they inevitably bend their policies and messages to benefit these funders. Many partner with deep-pocketed companies who cosponsor events and initiatives that the nonprofit could not have pulled off without such partnership. And here, as between industry and the government, there is a revolving door that provides an additional incentive for nonprofit executives and researchers to tune their actions to an industry-approved key. Those same industries might hire them as lobbyists or “thought leaders,” also known as “key opinion leaders”—prominent physicians or medical researchers who have proven effective at influencing their peers—after their nonprofit stint ends.
Let’s take a closer look at some of these nonprofits: two disease societies and two professional groups with which I’m quite familiar.
THE AMERICAN CANCER SOCIETY (ACS)
The ACS is dedicated to eradicating cancer worldwide. They fund research, sponsor patient education, galvanize the public into action, and remove the taboos against mentioning “the C word,” all of which make the world a better place for cancer victims and their loved ones. The ACS’s courageous campaign against the tobacco companies has significantly reduced smoking rates in the United States, and has succeeded in stigmatizing tobacco use. So who would be so Scrooge-like as to impugn their work? Say a word against them and people respond as if you’ve confessed a fondness for cancer. But the ACS is one of the big obstacles to reducing cancer rates in this country. Called “the world’s wealthiest non-profit” by Samuel Epstein, author of the 2011 book National Cancer Institute and American Cancer Society: Criminal Indifference to Cancer Prevention and Conflicts of Interest,3 the ACS guides hundreds of millions of dollars per year into cancer screenings and medical research, and almost none into research or advocacy about diet. While Epstein’s book focuses on environmental causes of cancer at the expense of nutritional ones, his exposé of ACS duplicity and conflicts of interest is required reading for anyone still under the ACS’s spell.
If you were in charge of a wealthy and powerful organization dedicated to eradicating cancer, what would you want its positions on cancer research to look like? Mine would begin with a research program designed to understand the natural biological complexity of this disease, and then would try to take advantage of nature’s tools to restore health. I’d encourage a wide diversity of research: reductionist and wholistic, mechanistic and dynamic, palliative and curative, reactive and preventive. (The more varied the research and interventions, the greater the chance of discovering something new—of stumbling upon a true breakthrough.) And I’d spend the vast majority of the funds I was given attempting to inform the public about what we do know regarding the role of nutrition in the prevention and treatment of cancer. By contrast, the ACS looks for simple solutions involving chemicals used to selectively kill cancer cells, a synthetic approach that ignores nature’s means of restoring and maintaining health. In these aims, the ACS is indistinguishable from the PR departments of companies like AstraZeneca, the pharmaceutical company that has funded the ACS’s breast cancer awareness drives, and, not coincidentally, manufactures and markets several breast cancer drugs; and Amgen, the biotech firm whose CEO, Gordon Binder, served as an ACS board member. In addition to AstraZeneca and Amgen, the following companies are on the ACS “Excalibur Donor” roster, signifying annual contributions of $100,000 or more: Big Pharma companies Bristol-Myers Squibb, GlaxoSmithKline, Merck, and Novartis; and biotech company Genentech.4
With one exception—the ACS’s laudable and successful multi-decade crusade against smoking—the research and advocacy ACS funds is all about “preventive screening” (since when is a diagnosis of a late-stage existing condition considered prevention?) and molecular mechanisms of cancer development that might lend themselves to the latest toxic drug or genetic manipulation.
Mammography, the most common and lucrative form of breast cancer screening, is one of the pillars of ACS practice and philosophy. Epstein points out that five past presidents of ACS have been radiologists, and DuPont, a manufacturer of mammogram film, heavily funds the ACS Breast Health Awareness Program. The ACS’s Breast Cancer Awareness Month culminates with National Mammography Day, an event underwritten by their corporate sponsors. ACS not only heavily promotes mammograms, it also ignores government guidelines on breast cancer screening when those guidelines threaten the pocketbooks of their sponsors. In 2009, the U.S. Preventive Services Task Force found that the risks of annual mammograms outweighed the potential benefits in women under 50 and so recommended routine biannual screening starting at that age.5 The ACS, beholden to the radiation industry, still promotes annual mammograms for women starting at age 40.
The ACS doesn’t just receive funds from pharmaceutical and health insurance companies; the junk food industry is also a generous and energetic contributor. ACS’s Excalibur Donors list includes Wendy’s, McDonald’s, Unilever/Best Foods (maker of hundreds of food brands, including Rama margarine, Bertolli olive oil, Hellmann’s mayonnaise, Knorr soup mixes, and Ben & Jerry’s ice cream), and Coca-Cola. And, perhaps unsurprisingly, ACS does not take a hard stance on anything related to diet. ACS’s diet recommendations (buried several directories deep on their website6) are vague and unthreatening to their funders’ bottom lines. Examples of current diet recommendations include:
♦ Read food labels to become more aware of portion sizes and calories.
♦ Eat smaller portions when eating high-calorie foods.
♦ Limit your intake of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks.
♦ Limit your intake of refined carbohydrate foods, including pastries, candy, sugar-sweetened breakfast cereals, and other high-sugar foods.
♦ Choose fish, poultry, or beans instead of red meat (beef, pork, and lamb).
♦ If you eat red meat, choose lean cuts and eat smaller portions.
These recommendations hold no real financial risk for the meat and junk food industries. The ACS’s recommendation to limit certain foods (not avoid them) is the equivalent of telling junkies to “limit your intake of cocaine.” Not serious enough to make an impact on anyone reading them, and definitely not strong enough to make a meaningful difference in anyone’s health. (How far this organization has strayed from its inception a century ago, when its founder, Frederick Hoffmann, advocated the study of nutrition as a key factor in cancer development! Hoffmann was removed from its board of directors three years later, then belittled at their first annual conference in Lake Mohonk, New York, in 1922.)
You may be wondering why I didn’t include some tepid ACS recommendation about “limiting intake” of dairy products. That’s because there is none. Despite all the evidence, the ACS doesn’t mention avoiding or reducing consumption of milk or cheese, or dairy of any kind, in its recommendations. In fact, according to the January-February 2008 Digest of the National Dairy Council, the ACS recommends that both men and women reduce their risk of colorectal cancer by increasing their calcium consumption “primarily through food sources such as low-fat or non-fat dairy products.”7
ACS doesn’t content itself with promoting surgical, pharmaceutical, and radiological approaches to cancer treatment and prevention. The society actively funds vicious attacks on those who promote “alternative” cancer therapies, treatments, and prevention recommendations. Their Subcommittee on Alternative and Complementary Methods of Cancer Management (originally called, and still informally known among its staunchest administrators and supporters as, the Committee on Quackery8) denies funding to and in effect blacklists any practitioners who advocate natural, non-patentable, and nonmedical approaches to cancer treatment. (Just in case you’re wondering if a WFPB diet qualifies as “quackery,” two of ASC’s “Signs of Treatment to Avoid” are: “Does the treatment claim to offer benefits, but no side effects?” and “Do the promoters attack the medical or scientific community?” Talk about being paranoid!)
I’ve experienced this ACS animosity personally, via a smear campaign against me and my research. In the early 1980s, diet and nutrition topics were off their radar screen almost entirely. Only begrudgingly did they give a passing nod to nutrition, when the NAS produced the 1982 report on diet, nutrition, and cancer that I coauthored. About that same time, a group of private fundraisers formed a new cancer research society, the American Institute for Cancer Research (AICR), for which I acted as the senior science advisor until 1986, and then again from 1990 to 1997. The AICR’s sole mission was to emphasize the dietary causes of cancer. At first, I naïvely believed that a society dedicated to the eradication of cancer would welcome any research or policy avenue that showed promise in slowing or reversing the progression of the disease. I was wrong, though; the ACS turned out to be highly hostile to the AICR. I was surprised to find myself personally vilified in a memo about the AICR that the ACS president sent to their local offices around the country. The National Dairy Council promoted this memo to the press; it was even mentioned by advice columnist Ann Landers!
A few years later, after the AICR had become successfully established (and the ACS finally recognized it was here to stay!), the ACS invited me to be one of the six permanent members of their new panel of experts for evaluation of research grant proposals focused on the role of nutrition in cancer control. (By “permanent,” I mean that I was allowed to hold the position as long as I wanted, based on their acceptance of my role in the initiation of the AICR.) I believed this represented a refreshing change of heart at the ACS, a new and sincere interest in the association of diet and nutrition with cancer. I served for a couple of years, then had to resign because of an overextended personal workload. Although I couldn’t articulate it well at the time, I was becoming disenchanted with their focus on highly reductionist research.
A few short years later, with some new management and another change of heart, the ACS returned to their anti-nutrition roots by sponsoring the 2003 “Cattle Barons Ball” in Atlanta (their headquarters) as part of their annual fundraising drive. I questioned their behavior, given the known links between consumption of animal protein and cancer, and received a response from the then-president of ACS. She said that this ball was “not about beef,” that the “event [had] no association or partnership with the beef industry or its interests nor does it articulate an endorsement of the beef industry by the Society.” It was just a “fun” event.
I suppose some might accept this explanation based on a narrow technicality; they weren’t suggesting those attending the event increase their consumption of beef. However, given the ACS’s expertise in public relations—that’s their business—it’s hard for me to imagine they believed their own line. They’ve never held a “Marlboro Man Marathon” to raise money for cancer research.
The ACS may have avoided a formal partnership with the beef industry to avoid adverse publicity likely to arise from such a relationship, but it had a lot to lose if they were to advocate a plant-based diet, to the detriment of those cattle barons’ bank accounts. The ACS very much supports the treatment of cancer with chemicals, and animal-product-free nutrition does not fit into such plans. Given its coziness with those cattle barons, it’s not surprising that, to this day, serious research on the role of nutrition in cancer occurrence and treatment is an almost nonexistent priority for this all-American organization.
THE NATIONAL MULTIPLE SCLEROSIS SOCIETY (MS SOCIETY)
The MS Society provides another example of a disease organization whose impartiality and professed desire to improve human health is belied by the combination of its corporate funding and dogmatic anti-evidential stance.
Like the ACS, the MS Society depends on the food and pharmaceutical industries for the bulk of its donations. While direct donations from pharmaceutical companies total just 4 percent of the organization’s 2011 annual revenue of $165 million9 and other corporate donors provide another couple of million dollars each year, these companies are intimately involved with the events that drive the bulk of the MS Society’s fundraising: the hundreds of walks, runs, and bicycle rides organized by good people who believe in their contribution to the cause. The big website sponsors of the Bike MS project are Pure Protein, a company that makes nutraceutical bars, shakes, and powders—“nutrition” that promises health but delivers a scary mix of processed ingredients, including sucralose, hydrolyzed collagen, sorbitol, maltitol powder, and palm kernel oil—and the pharmaceutical company Novartis, which manufactures and markets the MS drug Gilenya.
Poking at random through the MS Society website, I kept stumbling upon the society’s financial dependence on companies that profit not from a cure but from the sale of processed foods that could contribute to onset of the disease. A local North Carolina MS chapter is sponsored by the Golden Corral restaurant chain. Sara Lee raised $111,000 in 2011 through their “Summer Bun Program.” Sara Lee’s parent company, Bimbo Bakeries USA (no, I am not making that name up), ran a summer 2012 promotion in supermarkets across the country to raise money for the MS Society through the sale of its other brands of junk food, including Stroehmann, Freihofer’s, and Arnold breads and baked goods.
The MS Society clearly delineates the benefits of corporate sponsorship of its Women Against MS Luncheon as including “tangible marketing benefits,” including “product sampling, brand exposure, and media exposure.”10 What isn’t mentioned (but is understood loud and clear nevertheless) is that associating their corporate brand with the MS Society’s name implies to consumers that the brand’s products will aid in the “fight” against MS, or at the very least won’t contribute to the problem of MS in the first place—something that, in the case of all these processed food sponsors, is not the case.
There is impressive evidence that high levels of milk consumption correlate with high rates of MS prevalence, and long-term studies show much lower death rates among MS patients who ate a plant-rich diet (5 percent, compared with 80 percent for those who consumed an unhealthy diet).11 But the MS Society website has almost nothing to say about the role of nutrition in preventing and ameliorating the disease. The sum total of its general advice about nutrition:
Maintenance of general good health is very important for persons with MS or any chronic disorder. A well-balanced and carefully planned diet will help to achieve this goal. MS specialists recommend that people with MS adhere to the same low-fat, high fiber diet that is recommended for the general population.12
In more detailed documents, the MS Society recommends lots of low-fat dairy (for calcium!) and lean meat (for protein!) as part of its MS diet, along with the usual lip service about eating fruits and vegetables. Not a peep about the demonstrated correlation between dairy consumption and MS. Not a word about the profound impact diet has been shown to have on MS survival rates. In short, the MS Society is all about whitewashing the causes of MS, coincidentally absolving its junk food sponsors of culpability while promoting its pharmaceutical sponsors’ products and research initiatives as our best, only hopes of defeating this dread disease.
THE ACADEMY OF NUTRITION AND DIETETICS (AND)
Unlike the ACS and MS Society, the AND (until 2012, the American Dietetic Association) focuses not on a disease, but on a professional constituency. It exists to serve registered dietitians: those who advise hospitals, schools, clinics, daycare centers, government agencies, and the general public about what constitutes a healthy diet. The result is a substantial amount of influence over the way we think about nutrition in this country. Unfortunately for dietitians and the public they mostly misinform, the AND recommendations are tailored to the financial interests of its junk food industry sponsors.
While the AND gets much of its operating capital from member fees for services (including publications, accreditation, continuing education, and discounted attendance at annual meetings) and tax-deductible donations, they also solicit the for-profit private sector for donations. According to its 2011 annual report,13 its generous “partners” include Aramark, The Coca-Cola Company, the Hershey Center for Health & Nutrition; and the National Dairy Council. “Premier” sponsors are Abbott Nutrition; Coro-Wise (a supplement-making arm of Cargill); General Mills; Kellogg; Mars, Incorporated; McNeil Nutritionals; PepsiCo; Soyjoy; Truvia (marketer of a sweetener manufactured by Cargill and Coca-Cola); and Unilever. The National Cattlemen’s Beef Association and the National Dairy Council, along with many junk food manufacturers like Mars, PepsiCo, and Coca-Cola, were specially thanked in the report for donating at least $10,000 each to the AND.
I’ve lectured at the very large AND national meetings three times, at the request of a specialty group within the organization interested in vegetarian nutrition. The last time, in Chicago, prominently displayed on the outside of my registration bag were the names of the ADA partners, a veritable rogues’ gallery of food and pharmaceutical interests. It was a nice mix of partners, with highly synergistic agendas: one group (food industry sponsors) serves up soft drinks and milk products for school lunch programs across the country, while the other (pharmaceutical sponsors) peddles drugs for the ailments that these programs cause.
What I find especially repugnant about the AND is its stifling influence over nutrition education. The AND controls the content of the courses required for the registered dietitian degree in colleges and universities, as well as the criteria by which individual states license registered dietitians. The AND is also responsible for the training and licensing of other nutritionists across the country, through the Commission on Dietetic Registration (CDR). Only those nurses and dietitians who participate in AND’s mandatory Professional Development Portfolio recertification system can maintain “registered” status, and the CDR determines who is allowed to provide this ongoing education, so crucial to those who wish to work in healthcare settings and be eligible for insurance reimbursement.
My friend and colleague, Dr. Pamela Popper, has experienced the AND’s vicious anti-free-speech actions firsthand. She tells the story in harrowing detail in her excellent book Solving America’s Healthcare Crisis. In 1993, she started a company that taught classes on plant-based nutrition in her home state of Ohio, thus incurring the ire of the Ohio Board of Dietetics. They investigated her, subpoenaed her to “name names” of other “non-dieticians” who were teaching nutrition so they could also be investigated, and actually threatened her with jail time. Beth Shaffer, the Board’s compliance specialist, informed Popper that there are no First Amendment Rights in the State of Ohio when it comes to discussions about food and nutrition.14
Unlike most of the people bullied by the dietetic industry, Popper fought back. She spent tens of thousands of dollars of her own money, hired the top lawyers in the state, and ultimately succeeded in legalizing her business in Ohio. In an email, she shared with me a slide presentation given by the former Executive Director of the Ohio Board of Dietetics and current Chair of the AND Licensure Workgroup, Kay Mavko, urging and instructing local dietitians to “turn in” their competition to state licensing boards.15 Just in case you think I’m being cynical or paranoid about the AND’s real goals, I’ve reproduced a few of the slides in Figures 18-1 through 18-3.
FIGURE 18-1. Slide from an Academy of Nutrition and Dietetics presentation
Note that last bullet in Figure 18-1: “Licensing Boards need continual incidents to investigate.” Without continual complaints, the Licensing Boards have nothing to do. Another slide warns of the danger of “sunset”: that idle boards could be dissolved for lack of function. Dietitians must keep them busy! Again, the slide presentation says it far more eloquently than I can; see the slide in Figure 18-2.
FIGURE 18-2. Slide from an Academy of Nutrition and Dietetics presentation
But surely Kay Mavko and the AND are engaging in this witch hunt with good intentions. They’re just trying to protect the public from what they see as bad nutritional advice from those who have not gone through the AND’s rigorous accreditation process. Right? Again, Mavko’s slide presentation sets the record straight. Take a look at the slide in Figure 18-3.
If registered dietitians are complacent, “other groups may gain a competitive advantage.” You must protect “your scope of practice.” Wow! You can see why this slide show isn’t on the AND website, and why it was leaked to journalists by renegade AND members who were appalled at the idea of being turned into AND spies.16
The AND and its state board allies feel threatened by nutrition education that doesn’t toe the official AND line because they fear for their jobs. That’s understandable, as long as the public and regulators realize that the AND is, as Dr. Popper noted, “a trade group, not an authority on nutrition and health.”17
Dr. Popper isn’t, in AND’s eyes, a legitimate source of nutrition information. So who is? The answer turns out to be the same industry and companies that pay the AND’s bills. Some of the education providers approved by CDR include pharmaceutical giant Abbott Labs, food service providers Aramark, Sodexo, and Sysco, and front groups for the junk food industry, including the transparently named Coca-Cola Company Beverage Institute for Health & Wellness, ConAgra Food Science Institute, General Mills Bell Institute of Health and Nutrition, Kraft Foods Global, Inc., Nestle HealthCare Nutrition, PepsiCo Nutrition, and US Foods.18
FIGURE 18-3. Slide from an Academy of Nutrition and Dietetics presentation
Just in case some junk food manufacturers don’t quite grasp the benefits of becoming an accredited provider of continuing professional education for AND members, the CDR website spells them out clearly under the heading “Marketing Opportunities”:
♦ “[E]xposure to a market of over 65,000 credentialed dietetics professionals.”
♦ “[P]romotion of individual CPE [continuing professional education] activities in the CDR CPE Database, which is available to practitioners via mail, fax, phone, and online.”
♦ [L]isting “as an [sic] CPE Accredited Provider on CDR’s website.”
♦ “[A]pproval to use the CDR CPE Provider Accreditation logo while marketing CPE activities and materials.”19
Talk about foxes teaching the hens about security fencing!
It is my experience that the education programs of all-powerful organizations very much defend the status quo, especially the so-called health value of dairy products for young people. They like to claim that they have a vegetarian subgroup in their organization, but it’s treated more like a politically expedient stepchild than a true member of the AND family. As well, vegetarianism is still a far cry from the WFPB nutrition the research recommends; it cuts out meat, but still allows significant amounts of dairy products, eggs, and processed foods that prevent radiant health and freedom from disease.
The AND’s work extends beyond educating (indoctrinating?) dietitians. In 2011, they also donated $62,000 to congressional candidates to promote their political agenda. What a great way for Coca-Cola, Pepsi, and others who donate to the AND to “launder” their political influence! AND, in effect, is turned into a highly credible PR agency for its corporate allies. Through its advocacy, public relations, and mandatory education partners, it serves as a front for the food and drug industries and their interests.
It saddens me to say these things because in my experience, the AND’s individual nutritionist members are the most knowledgeable professionals on nutrition I meet in my public lectures, skilled at presenting nutritional material to the public and unusually motivated in their work. What I find repugnant is the organizational constraints placed on these members, often without their awareness, about what is and is not acceptable opinion.
AMERICAN SOCIETY FOR NUTRITION (ASN)
I include the ASN (originally the American Institute of Nutrition) in this discussion not because they’re a particularly egregious offender, but because I’m intimately familiar with the subtle and corrosive effect of corporate money on this once-fine organization. To their credit, they have developed a conflict of interest toolkit designed to root out obvious attempts at hanky-panky. Yet the influence of industrial profit is so pervasive within the system that no overt attempts at self-regulation, no matter how sincerely meant, can be truly effective.
I have been a member of this society for forty-five years and was very active in it for many of them. They held their national research meetings in conjunction with five (later six) sister biological societies, collectively known as the Federation of American Societies for Experimental Biology. At their peak, these annual five-day meetings attracted about 20,000 to 25,000 biological scientists. I greatly enjoyed the atmosphere and candid exchanges with colleagues on our research findings. Some of my more memorable recollections are of the awards given to my students, the symposia that I organized or participated in, and the exchange of research ideas in the formal presentations.
However, one thing always bothered me, and it only became worse over the years: the so-called prestigious awards given annually to various established researchers, usually along with award money provided by food and drug companies. Each award was modest, ranging from $1,500 to $5,000 apiece, but in total (approximately $40,000 to $50,000), the awards represented a powerful monetary influence that steered the ASN away from honest statements about nutrition. Industry knows that even small rewards can buy loyalty from researchers who, given a range of topics to study, simply find it easier and less uncomfortable to pursue research that does not implicate the products sold by their grantors.
When I became more involved in leadership positions of the society, I began to see the much-too-close involvement of these companies in its affairs. One of the more significant, at least for me, was the attempt by certain society members—prominent consultants to the American Egg Board, the General Mills Company, and other industries—to propose having me expelled from the society, the first time such an attempt had been made against one of its members in their forty-year history. Apparently, I had committed the ominous sins of (1) assisting as senior science advisor to the new cancer research organization, the AICR, to focus their efforts on nutrition with a bias toward plant-based foods; and (2) being a prominent member of the 1982 NAS committee on diet, nutrition, and cancer whose report brought focus to the cancer-prevention properties of plant-based foods. After an investigation, the society’s eight-member executive committee voted 6–0 (with two abstentions) to absolve me of any wrongdoing. Still, this was an aggressive attempt by the industry-oriented members to silence me. As you can tell, it didn’t work!
Professional societies protect their existence (and present and future funding) by aligning themselves with the traditional food and drug companies and their interests, avoiding as much as possible any mention of the possible health benefits of the WFPB diet. Having been part of several professional societies, I can assure you that they almost never accept findings that favor such a diet—and this includes the societies to which I have long belonged.
DAMAGING EFFECTS
Maybe you’re wondering, what’s the big deal? After all, these societies are free to publish, promote, and pay for any nonsense they like, and so are you and I. Training nutritionists and influencing research scientists isn’t the same as dictating what we eat (how many of us have gone to a nutritionist?); these societies therefore seem easy to ignore. The problem is that because they are empowered by industry funding and granted quasi-governmental status to determine who is allowed to study and teach nutrition, and who can be marginalized or even disciplined for deviating from the party line, they are able to influence government policy, medical practice, and public perception far out of proportion to their financial weight, and in a number of different ways. I know something about this unprofessional behavior both from their investigation of my professional activities and from my tenure as liaison for the ASN and its sister societies to the budgetary process of the U.S. Congress.
First, they exploit the perception that they occupy some moral high ground in the battle against disease. To oppose them is to lend support to the enemy: the diseases that threaten us and our loved ones. Anyone who has had to explain to a neighbor suffering from breast cancer why they won’t donate money for a pink ribbon, walkathon, race, bake sale, talent show, house party, reading group, or power lunch “for the cure” know the social ostracism that can result. As we’ve seen, most people suffering from a disease, as well as their loved ones, cling to hope in the medical establishment. After undergoing a surgery, drug regimen, radiation, or chemotherapy that improves function and staves off further degeneration, they may become active cheerleaders for current medical practice and evangelists for the “cure around the corner.” Corporations like Astra-Zeneca and Merck can’t command this passion and activism directly, but through nonprofits they convert well-meaning people’s desperate energy into quarterly profits.
Advocacy and fundraising organizations in particular lay claim to a manufactured legitimacy that they have bestowed upon themselves, and few elected officials, journalists, or business people have the knowledge, incentive, or guts to question those credentials. When ACS puts out a press release, even the most respected journalists abandon impartiality as if they were local sports announcers openly rooting for the home team. Three cheers for ACS and its success in the War on Cancer, NewsHour and the rest of the mainstream press echo in tones of awed admiration.
Disease advocacy and professional organizations have also created the illusion of impartiality. All they care about, they tell us, is improving human health, either by wiping out their disease of interest or training their professional members in the best ways to deliver care. Because of this ostensible lack of commercial agenda, we trust their guidelines and research evaluations. When AstraZeneca tells us that tamoxifen is a safe and effective treatment for breast cancer, we know that, whether accurate or not, it is self-interested advertising. But when the ACS makes the same claim, we accept it as truth.
Perhaps the most serious effect of these nonprofits’ collusion with industry is the “halo effect” that extends from these supposed saints to the corporations whose interests they promote. With industry’s sales and marketing machines cloaked in mantles of charitable virtue, no wonder most Americans don’t realize that the junk that passes for food is in fact the biggest contributor to our health crisis, and the junk that passes for medicine keeps us just well enough to continue to spend on both the food and the medicine.
THE ABDICATION OF PERSONAL RESPONSIBILITY
The upshot of this insidious industry influence over institutions that are supposedly helping us become healthier is a complete abdication on the part of most Americans of responsibility for their own health outcomes. It’s not their fault; the nonprofits have indoctrinated us to believe that we don’t have much influence over our own health—that all we can do is donate, march, run, and wear pink or yellow ribbons to help rid the world of these scourges. The fact that the vast majority of us can virtually eliminate our risk of premature death from cancer, heart disease, stroke, Type 2 diabetes, and dozens of other diseases is actively denied by the very societies who purportedly want to end these diseases. I’m sickened by the billions upon billions of dollars and the millions upon millions of volunteer hours that are redirected away from nutrition and toward reductionist, patentable, profit-generating distractions. And the most heinous misfortune of all is that the well-meaning people supporting these three societies honestly believe that they are doing socially conscious and constructive work to honor friends and family members who lost their lives to these diseases.
Here’s an example that crossed my desk just as we were finalizing the manuscript: an October 3, 2012 blog post on the ACS website by Dr. J. Leonard Lichtenfeld, Deputy Chief Medical Officer for the ACS national office, with the title, “During Breast Cancer Awareness Month We Must Not Only Celebrate Our Success but Also Understand Our Limitations.”20 The post, well-written and heartfelt, expresses sensitivity toward women whom the medical establishment could not help even while celebrating the contributions made by the latest screening techniques. Lichtenfeld writes:
I understand the anger of women with advanced breast cancer who say, “What about me?” Among these women are those who did everything “right” when it came to early detection and treatment [. . . .] These are women who pray for a breakthrough, who pray for a cure and wonder whether those who have not been diagnosed with breast cancer or who don’t have advanced disease really understand.
These are moving, consoling, compassionate words. And yet they are utterly disempowering. Women with breast cancer, he advises, pray for a breakthrough. Pray for a cure. For your salvation lies in the hands of those who compound new drugs, who invent new radiation machines, who pioneer new surgical techniques, and who find new ways to manipulate genes. Even as he expresses humility and remorse on behalf of the medical establishment for having “oversold [their] magic,” for having “overpromised and sometimes underdelivered,” he’s still selling reductionist treatment as these women’s only hope. Not a word about prevention. About empowerment. About the fact that simple changes in diet may turn off cancer progression.
It’s the same message everywhere in our health-care system, and this disempowerment—whether well-intentioned, as I suspect is the case for Dr. Lichtenfeld, or cynically in pursuit of profit—is the most obscene part of the whole story.
While the world is rife with unethical behavior, it would be a mistake to blame the problems I have discussed up to this point solely on individual morality. If we limit our sight to individual players, we’ll never see the big picture. The issue is a systemic one, maintained by interconnected actors, all acting in their self-interest to further their goals. The trouble is not, or not always, the actors themselves, or their intrinsic motivations. Instead, it’s the overarching goal of the entire system that’s at fault: corporate profit above public health.
I’ve picked on the ACS, MS Society, AND, and ASN not because they’re any worse than the hundreds of other disease advocacy societies and professional associations, but because they’re the ones I’m most familiar with. They aren’t “bad apples” in an otherwise good barrel; rather, the barrel itself, the system in which money talks and reductionism is the official language, is the source of the ethical rot. It rewards societies and associations that lend their moral might and PR prowess to expensive and ineffective reductionist approaches while ignoring or impugning the true preventive power of nutrition.