Monday, December 1, 2008

Journal Reflection

I think one of the most important things I have taken from this book and this class is that I am, and always will be, part of the policymaking process. The only aspect of this I can choose is whether I take an active role, or let my silence speak for me.
I'm also pretty happy with the way my perception of the political process has changed. Although I still find it confusing and often shady, I no longer look at it as something completely removed from myself. I am confident that with a little bit of time for background research, I could understand the framework of most policies being formed today. Being able to do stakeholder analyses has helped me understand the push and pull of policy creation, and I've gotten pretty good at putting on my "industry glasses," and considering the economic perspective.
I think the framework that I've set for myself, and the skepticism that I've learned to harbor, will help me professionally, when I have to slough through politics to find the truth as it applies to me and my patients. I still don't think I'm proficient enough in the workings of the government itself, and the checks and balances among congress, senate, and non-partisan committees. I'd like to do a bit more digging into the topic of herbal remedies and dietary supplements; I'm still pretty fuzzy as to the difference between structure-function and medical claims. I'd also like to know a little more about the requirements for clinical research when products are found to be harmful, and how many people have to complain to the FDA before attention is paid.
All in all, Food Politics was successful in making me angry and skeptical, very nearly disheartening me in the process, but left me with a feeling that there is a great potential for change.

Chapter 15: Selling the Ultimate Techno-food

Reading the policy background of Olestra was interesting, because I remember the "revolution" when it hit the market. My mother bought a bag of Nacho Cheese chips, and experienced the laxative effect after eating nearly the entire bag in one sitting. She says that the side effects she experienced after taking the Alli pill were much worse, though. My mother falls victim to health "phenomena" quite too often.
I admit that Olestra interests me from a scientific perspective: the idea that a calorie-free, macronutrient replacement can be created is pretty amazing. I must disagree with the principle of these food replacements, though. The theory that you can continue to eat crap and magically become healthy via robofoods is unrealistic, and even if initial success is achieved, old habits are often restarted. This leads to frustration and often leaves you more overweight than you started.
I'm also hesitant to trust lab-synthesized food replacements' safety. These molecules do not occur in nature, and the effects of long-term exposure to them has never been studied. Once again, I believe we should adopt the precautionary principle when approaching these pseudofoods.
A part of this chapter that really bothered me was the unlawful amount of control P&G seems to have over the policy process. Creating new patent laws to convenience them is beyond unethical. I have the urge to try not to consume any Proctor and Gamble products, but I suspect that would require that I start to hunt and gather.
What I think America needs is a psychological makeover. We need a better relationship with food. This overconsumption, guilt, compensation loop is getting quite old, and making us extremely unhealthy.

Chapter 13: Go Forth and Fortify

I have always believed that fortified foods are a science-light movement to squeeze extra money out of affluent, already nutritionally healthy people. I didn't realize until reading this chapter how useless fortification really is. It angers me that the only American populations who need the added help are also the only populations who probably cannot afford it.
The worst part of the fortification movement is that it is negatively affecting the American public. People are ignoring high salt, sugar, and saturated fat content because a label says "contains 40% of daily vitamin needs!" or "Great source of calcium!" The micronutrient obsession which plagues America has taken the focus away from common sense, and sent consumers on goose chase after goose chase, making sure they have enough of a particular vitamin or mineral. What happened to eating vegetables? Sensibility doesn't sell, I suppose. I understand what motivates industry: the bottom line. I also understand that the American consumers are often motivated by fear and paranoia. I believe the only way to get this craze under control is to re-educate. Maybe we need to forget many of the isolated micronutrient studies that have been conducted over the past 10 years.
This book makes very frustrated with the American consumer, because they're trying to act in their best interest, but often end up harming themselves. Industry, though it often acts in ways that aren't concerned with public interest, is at least achieving what it set out to do--make money, lots and lots of money.

Chapter 12: Deregulation and its Consequences

The sheer number of dietary supplements now in America makes it impossible for the FDA or FTC to keep up with health claims and safety problems. I'm not sure how this problem is being handled in Europe, but because they usually work in accordance with the precautionary principle, they are most likely more in control of their problem.
As I said before, I have no problem with people taking pills that aren't shown to have efficacy in biomedical trials. I only take issue with supplements that have been shown to be harmful at recommended doses. I believe it needs to be the responsibility of the manufacturer to prove that their substance isn't harmful before they are allowed to market that product. The only feasible way of doing this now, I believe, is to set a time point, and say that any substance not proven not to be harmful by that time must be removed from the market. This will doubtlessly cause a riotous outrage, so before it's possible, significant public concern must be raised. Such a policy could maybe be suggested on the tail-end of a very public supplement scandal.
Looking back, I think a good time for this would have been during the ephedra/diet pill craze. My mom was on phen-fen at the time, as I'm sure many other moms were, which means that many households had an interest in stopping such a situation from arising again. My mom believed that the fact that the drugs were bottled and on store shelves meant that they were safe.
In the future, I will make sure that my patients know that any pills they buy over the counter at a vitamin shoppe are probably not well tested, there is no guarantee that it is what it claims, and that they're taking them at their own risk.

Sunday, November 30, 2008

Chapter 10: Science versus Supplements: "A Gulf of Mutual Incomprehension"

I am hesitant to completely disparage any helpful effect provided by dietary supplements. While I, as a proponent of Western Biomedicine, do not believe that most herbs are helpful in treating Western diseases, I know that many folk remedies are extremely valuable to people who ascribe to other cultural beliefs. I think it is our responsibility as nutritionists to consider that biomedicine is not universal, and we must remain culturally competent in order to be able to help people across cultural borders. As much as the scientific world hates it, the placebo effect and nocebo effect exist, and play a big part in personal health.
There is one exception to my tolerance of folk medicine: I do not believe that any supplement which can be harmful at recommended doses should be allowed to be on the market. Consumers have some freedom to choose for themselves whether to spend money on remedies that might not have any effect, but the choice should be taken away from them when the substance threatens their health.
I do not at all agree with the rampant use of health claims in product advertisements. I believe in the precautionary principle when it comes to dealing with these claims, and peer-reviewed studies should be required to substantiate them. Also, the component of the food that "healthy" should be labeled and explained near the claim. For example, if all bran All Bran claimed to prevent colon cancer, the label should say: this product contains fiber, which helps prevent colon cancer, as does any product which contains substantial amounts of fiber.
The use of dietary supplements should be limited, because they provide an excuse to eat less nutrient-dense foods; an approach which unfailingly leads to lowered nutritional health.

Chapter 9: Pushing Soft Drinks: "Pouring Rights"

I must start my analysis of this chapter with a fact and a confession: soft drinks are one of the worst items, if not the worst single item that negatively affects American health. Also, I have been drinking large amounts of Diet Coke ever since I could walk.
I feel that my story has parallels to the situation of people born in the 30's and 40's, who took up smoking before it was widely acknowledged to be horrible for your health. Though I continuously cut back, it might be too late for me to completely remove the high-sodium, caffeine-riddled drink from my diet. When I compare myself with friends who didn't grow up with soft drinks in their homes, my relationship with soda is much more unhealthy. With the high-profile presence of sodas in schools, most children's exposure will probably be close to my own. Putting and keeping sodas in schools is dangerous and habit forming; I enthusiastically believe that public schools should not be allowed to make contracts with food corporations. These contracts undermine efforts to improve child nutrition, and add unnecessary calories to the diet of the already-overweight American youth.

Chapter 8: Starting Early: Underage Consumers

I have always been staunchly against advertising nonnutritious foods to children. I believe the fact that they don't have the mental capability to separate the program they are watching from the advertisements means that any influence exerted by industry is unfair and unethical. The effects of these advertisements stay with children throughout their lives, and makes healthful eating a lifelong struggle. Personally, I remember my obsession with Beanie Babies led to my eating a ridiculous number of Happy Meals in the mid-to-late 90's, when a teeny beanie baby was given away with every one.
The argument that it is the parents' responsibility to regulate the advertisement to which their children are exposed is unrealistic: these advertisements have permeated almost every faction of young life. A parent would have to lock his or her child in a room, and strictly regulate any form of media going in. This media includes, but is not limited to television, books, and comic books.
This advertisement needs to be strictly controlled, if not eliminated.

Chapter 7: Playing Hardball: Legal and Not

I wasn't really surprised to hear about price fixing in the "hardballing" chapter of Food Politics. The US government has come to rely too heavily on subsidization; it makes sense that industry would try their hand at it to reap a greater profit. These legal and illegal forms of price fixing are definitely stop-gap solutions. I'm not a fan of government subsidization either: I believe that it unfailingly leads to surplus, waste, and yet more subsidization. A particular quote in the Feed Additives segment struck me as particularly worrisome: "we have a saying at this company...our competitors are our friends and our customers are our enemies." This falls quite far from the American ideal: "the customer is always right."
I have no doubt that price fixing is much more common than is publicized. I do doubt that many Americans realize how far from a free market America has actually come. I think the eventual solution will have to be in the form of government regulation, but instead of regulating the cost only, I believe that the amount of food produced will have to be controlled as well.

Friday, November 28, 2008

Chapter 5: Co-opting Nutrition Professionals

The interactions between industry and academia are unavoidable; the only way to minimize corruption is total disclosure of alliances. I believe it’s possible to run a kosher experiment with corporate funding, as long as the methods and conclusions are subject to peer reviews. Most of this chapter outlined the difficulties I’d already known about when maintaining fairness amid corporate backing.

There was one exception to this: I was quite surprised by the segment about the ADA. I don’t think Nestle is upset enough about the subject of the ADA’s ties to industry. As a nutritionist, I’ve always considered the ADA to be the stronghold of nutritional knowledge. It is the responsibility of these professional organizations to give the best advice to Americans, and this is not possible from an organization that maintains “there is no such thing as a good or bad food.” In order for the ADA’s food recommendations to hold any credibility with me, they would need to start a firm, “eat less” line of campaigns.

Monday, November 10, 2008

Chapter 4: Influencing Government: Food Lobbies and Lobbyists

I have mixed feelings about chapter four. As much as my kneejerk reaction is to hate big business, I realize that large corporations are the backbone of the American economy. In the same vein, whenever I hear the word lobbyist, I immediately think the adjectives "corrupt," or "evil." Lobbyists, however, are the driving force of policy creation and alteration. It seems difficult to me, and I believe congress would agree, to draw a line between legal and illegal lobbyist actions. After all, American capitalism puts those with money into power, so shouldn't the amount of political power one has be proportional to wealth? Ideally, I think policy should be developed in which corporations are only able to exert power in those issues which do not affect the health or well-being of the public. In terms of nutrition I mean issues affecting food safety, and, I admit, also issues of trans fat, saturated fat, sugar, artificial sweeteners and additives. If my idealism were to continue, it seems I would move to outlaw McDonald's. As you see, I'm quite conflicted about the issue of lobbyists.

A subject about which I am sure of my feelings is the so-called "Revolving Door." I do not understand how congress has failed to address such an undeniably glaring conflict of interest. While every public servant comes into office with certain amounts of bias, it seems ludicrous to me that high-level private sector business people can so easily slide into a government role. The only solution I can think of for this is to put a waiting period on those seeking to transition from private to public sector. Maybe something like the top 5% of title holders have to wait 2-3 years after ending their role as a high-power private sector businessperson before seeking public office. This also becomes a bit convoluted, but I feel that it is something which must be immediately addressed.

Monday, September 29, 2008

Chapter 3: "Deconstructing" Dietary Advice

After reading chapter three and realizing how any dietary advice issued by the government is immediately twisted and skewed by multiple industries, I'm not sure if the advice is harming or helping. It is also frustrating that the recurring message--eat more plant foods and less of meat and processed foods--seems to be pushed aside for more interesting, profitable nuances.

It seems to me that much of the dietary advice given to Americans is kept purposefully convoluted. The focus on individual nutrients assures that consumers don't have a real grasp on the amount of food or which foods they need to eat. I would like to find a food guide which is completely removed from private sector influence, and relies only on science and logic. I'm not sure if such a guide exists, but it would be interesting to see how radically it differed from the government-sanctioned version.

My general feeling about government nutritional advice is that, while it definitely has a background of scientific research and evidence, the details and attitudes actually delivered are more likely to represent big business, and how you can make your interest in health work for them.

Thursday, September 25, 2008

Chapter Two: Politics versus Science: Opposing the Food Pyramid, 1991-1992

Chapter two considered a topic that I had never even thought to question: why is the USDA responsible for giving Americans nutritional advice? There is a definite conflict of interest in their "dual mandate" both to support agriculture and provide advice to Americans about health and wellness (Nestle, 53). I believe that once the scientific community changed their nutritional advice from "eat more" to "eat less," that there was no way for the USDA to administer guidance without compromising the health of the American people.
The timeline of the Food Guide Pyramid development was also quite illuminating, as I wasn't aware how controversial it was during development. The timeline confirmed what I suspected in my first post: the 2005 change to MyPyramid was actually a backwards move in terms of helping the American public understand the basis of a healthful diet.
Even thinking back to what I learned in elementary and middle school about nutrition (via the food pyramid), I'm not sure how much good it did me. The serving suggestions, which we memorized, didn't even enter my mind when I left health class and proceeded to the cafeteria. I wasn't strong enough to resist the piles of junk food, which were often much cheaper than the healthier options. I believe it would be worthwhile to begin to teach portion control and recognition of fullness in health classes. I'm not exactly sure what I would change, but from what I remember, health class was all about making sure you got enough: enough vegetables, enough grains. Overeating wasn't really discussed, and the only form of moderation that was encouraged was moderations in fats and sweets. I understand that these are empty calories, but even non-empty calories are still calories, and can still lead to unhealthy weight gain. Childhood is when we form our eating habits, and I can attest to the fact that it is a lot harder, and a constant struggle, to change your habits once they've been formed.

Wednesday, September 10, 2008

Course Goals, Introduction and Chapter One: From "Eat More" to "Eat Less," 1900-1990

COURSE GOALS

The most important thing I hope to gain from this class is confidence when approaching politics and policy situations. Right now it seems to me that everything involving politics is extremely convoluted and hard to follow, and involves laundry lists of organizations, committees, and law names. I would like to be able to follow the structure and organization of the policy process.
Professionally, I don't intend at the moment to become a policy activist. I do, however, intend to become involved in health care--a position in which I will often make use of nutritional policy. I hope that this class will help me look past the political bias of a policy, and make recommendations to my patients based on their best interests. For example, I would explain to my patients that strict following of the food guide pyramid is not the only road to nutritional health. Personally, I'm a vegetarian, and very close to vegan, and I have never had any nutritional deficiencies. The recommendation of three servings of dairy per day, while an acceptable way to get all the calcium one requires, is not the only way.

INTRO AND CHAPTER ONE

I’m not sure how to summarize my thoughts on Food Politics without an overdramatic rant. My take-home message from the first two chapters was that everything really is about money, and that the USDA is in place to protect the American economy as much the state of American nutrition. Because of the shackles that corporations have on the nutritional policymaking process, I think America is a very hard place to have a healthy relationship with food. The cycle of villianizing and glorifying single nutrients unfailingly leads to fad diets, which have been proven ineffective, and even detrimental to weight control and overall health. The USDA stresses personal responsibility in food choices, while at the same time creating policy that allows corporations to create a toxic environment for the American consumer. Remaining healthful in this environment feels a lot like swimming upstream, and once one responsible decision is made, there is always another temptation to follow.
Reading Food Politics reminded me of the 2005 change from the USDA Food Pyramid to the MyPyramid. This change, which I used to assume was for the betterment of American nutrition, now seems to embody the very things I dislike about USDA policy. First, the change from the pyramid scheme to the less suggestive triangular pie chart, seems to put all of the food groups on a more equal level. This removes some of the visual reinforcement of the idea that grains, fruits, and vegetables should form the base of the American diet. I now have little doubt that the meat industry influenced this, as an attempt to decrease the current stigma of meat products. Also, the “My” in MyPyramid stresses the idea personal responsibility, and suggests that a failure to maintain your nutritional health is your fault entirely. Overall, I’m feeling more than a little bit disillusioned when it comes to government motivations and support for my health, but better equipped to see through it all, and decide which guidelines work for me.
 


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