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Nutrition in a Second-Rate Hen House

This week, Wal-Mart announced the release of its home-grown, front-of-pack nutrition guidance system. Can we possibly be that gullible? If so, we probably all deserve to be eating whatever the big companies selling food tell us we should.
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This week, Wal-Mart announced the release of its home-grown, front-of-pack nutrition guidance system. In the world we actually live in, a world that runs on some bizarre admixture of Dunkin' and BS, I guess this is fine. Bully for Wal-Mart!

But in any other world -- a world where common sense were actually common, for instance -- the only possible reaction to such an announcement would have to be: What the f... heck is wrong with us? Can we possibly be that gullible and stupid? If so, we probably all deserve to be eating whatever the big companies selling food tell us we should.

Imagine a world in which Toyota announces its new rating system for car of the year, and everybody's okay with it. No more need for Motor Trend, or Car & Driver. From now on, we can simply count on Toyota to give us completely reliable, unbiased assessments of their own cars -- and everyone else's.

And then, if it just happened that Toyota, using its own criteria, won "Car of the Year" every year, and if Honda always finished somewhere near the bottom, we would accept this as good information on which to base our car selections. We asked for it, we got it: Toyota! Car of the year, every year.

Imagine if there were no Consumer Reports. Imagine if Maytag conducted the only objective, unbiased assessments of everybody's appliances -- including their own. Oreck generated the criteria and issued the reports evaluating every company's vacuums. Imagine the Wine Spectator, the Wine Enthusiast, and Robert Parker all called it quits -- and Manishewitz took over for them (heaven forbid!).

And why stop there? Instead of using any objective or valid measure, the makers of appliances and air conditioners and light bulbs could all invent their own measures of energy efficiency, and then tell us which of their products met the criteria they made up.

No need to use miles-per-gallon to rate fuel efficiency; auto makers could design their own criteria and then give us the enormously useful information that their cars did, or didn't, meet their "yes, fuel efficient!" measure.

Greyhound might as well take over for the National Highway Safety Administration and tell us whether or not their buses are up to code -- a code they invent. And let's go all the way! Why have an FDA when we could just let pharmaceutical companies devise their own criteria for drug safety and efficacy and put on their vials: "safe and effective" or... "not so much."

If you are having a little difficulty imagining such a world, there are a couple of good reasons why, rooted in hard-earned conventional wisdom. We've all heard "caveat emptor" and know that the buyer must take into account the motives of the seller. And we've all also heard the fox shouldn't be left to guard the henhouse.

To be fair to Wal-Mart, the criteria they are using to tell us which foods are "Great for You" and which foods are otherwise are, for the most part, pretty reasonable. The Great for You system represents a vast improvement over other such industry efforts as "Smart Choices," which told us Froot Loops were exactly that (Wal-Mart was at the table when Smart Choices was developed). It is also superior to "Facts up Front," another food industry initiative which simply takes some nutrition facts from the back of pack and puts them on the front. This would be a terrific idea if the rate-limiting problem in the average shopper's ability to discern better nutrition were their inability to rotate a bag or box through 180 degrees.

But there are some pretty serious limitations to a system that says a minority of foods are a "yes" and the majority of foods are a "no." Apple juice, canned chicken, walnuts, popcorn, iceberg lettuce and spinach all get the same "yes" score. Roughly four out of five foods -- ranging from lightly-sweetened green tea, to partially hydrogenated vegetable shortening -- all get the same "no."

With this in mind, I guess intelligence in the population could be usefully divided into "smart" and "not so smart." Albert Einstein, Isaac Newton, Stephen Hawking, and everyone who ever graduated college would be together in the top group. Is this truly useful information? Could college admissions committees or job recruiters do anything with it?

We physicians could divide the world into "healthy" and "not so healthy." Healthy would require, among other things, normal blood pressure, normal blood sugar, normal blood lipids. Failing that, into the "not so healthy" category you would go. So the "not so healthy" group would commingle those with LDL a bit too high but otherwise fine with those suffering from metastatic cancer or life-threatening trauma. Again, it's hard to see that this would be terribly useful to anybody.

This is the information we get from "Great for You." Some food makes the cut, most food doesn't. A food is in the top 20 percent or the bottom 80 percent. And, of course, there is a reason why companies selling food may not want to provide much more information than that. I'll leave you to guess what it might be.

I suppose we might settle for Toyota rating cars or Wal-Mart rating food if no one else would do it. But that's not the case with nutrition. There are a number of systems of variable merit around the world, which at least share the merit of not being devised by food sellers.

I, of course, have a favorite. I have devoted years of my life to working with top nutrition and public health experts to develop a nutrition guidance system that would be entirely independent of both industry and politics, and rigorously validated. We did so -- and to our knowledge developed the only nutrition guidance system in the world that has been shown to correlate directly with health outcomes, including all-cause mortality. The system has been endorsed by the American College of Preventive Medicine, and the AMA for that very reason.

I hasten to add that as the principal inventor of the algorithm that powers the NuVal system, I have wound up with some skin in the game. That's how entrepreneurialism works in America, and always has. But the success of a nutrition guidance system developed by health experts is measured in terms of public health, not food items sold. And, to put it bluntly, Edison's stake in the light bulb did not make it any less illuminating.

The system that came to be the ONQI, then NuVal, was first proposed to the federal authorities in the U.S. in 2003. When the algorithm was completed in 2006, it was offered to the FDA. It turned into a business-driven system only because the government didn't act.

That may be just as well. A private, protected system developed by nutrition and public health experts and owned by a not-for-profit hospital is entirely immune not only to food industry mischief, but to the kind of political mischief that defined a slice of pizza as a serving of vegetables.

But the mission here is not to praise NuVal -- I have done that before, with passion and conviction, and make no apologies for it.

The mission here is to question why we denigrate nutrition. Whey when it comes to nutrition, common sense goes into suspended animation. Why we tolerate a mishandling of nutrition guidance we would tolerate in no other industry. Why what would be "marketing" in any other industry is called "guidance" in the food industry. And why we tolerate all this when nutrition is, without question, one of the most profoundly important and universally relevant determinants of health outcomes there is -- for us and our children. Why?

Honestly, I haven't a clue.

We generally don't let foxes guard hen houses. Not hen houses we care about -- like cars and vacuums and washing machines.

Nutrition, it seems, isn't in such a quality hen house. So, when you walk by the farm we all seem willing to sell, you'll recognize it: It's in the second-rate hen house, with the fox out front.

You can wave at the fox if you want, but he won't wave back. Ostensibly, it's because he's on guard duty. In reality, it's because he's too busy eating.


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