The ongoing controversy about the American Academy of Family Physicians’ (AAFP) acceptance of grant money from the Coca-Cola Corp. to help fund its patient-education website, FamilyDoctor.org, flared up again this week.
The group’s own journal, Annals of Family Medicine, published a scathing criticism of the policy by Dr. Howard Brody, a bioethicist and professor of family medicine at the University of Texas in Galveston.
“When a learned professional society such as AAFP encounters ethical criticisms of its actions, and in reply can offer primarily rationalizations rather than sound ethical arguments, the character of the organization is called into question,” Brody writes.
Several of the rationalizations put forth by AAFP for accepting the Coca-Cola money are simply straw man arguments, says Brody. AAFP has argued, for example, that just because Coca-Cola’s products may contribute to obesity, that doesn’t mean the company is evil. But, as Brody notes, no one is asserting that Coca-Cola — or any of the other companies involved in AAFP’s “Consumer Alliance Program” (Brody suggests it should be called the “Corporate Alliance Program”) — is the devil incarnate:
We live in a capitalist society, and it is both legal and ethical for companies to market their wares. The problem is not good vs evil but differing interests (or duties). 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.
AAFP’s officials insist that they, not Coca-Cola, have final say over the content on FamilyDoctor.org. Furthermore, says the group’s president, Dr. Lori Heim, in an editorial response to Brody’s criticism, just because people perceive the existence of a conflict of interest, doesn’t mean that one actually occurred.
But, as Brody counters, even “if the final educational material includes a strong statement against sugary soft drinks, we will never know whether, absent the Coca-Cola funding, the statement would have been even stronger. That such questions will inevitably be raised shows the conflict of interest is both present and serious, quite apart from the eventual contents of the educational materials.”
The dog that didn’t bark?
As proof that AAFP has “scrupulously adhered to its core principles of separating editorial content from the influence of financial support,” Heim points to these excerpts from FamilyDoctor.org, which appear under the section “Added Sugar: What You Need to Know”:
There are serious health consequences to consuming added sugar. Too much added sugar in your diet can contribute to tooth decay, obesity, difficulty controlling type 2 diabetes, higher triglyceride levels, lower high-density lipoprotein (HDL, also called “good”) cholesterol levels, and heart disease.
Also, if you fill up on foods or beverages that contain added sugar, you are less likely to consume healthy foods and beverages that protect your health. For example, studies have shown that the more sugary beverages (such as soda or juice drinks) people drink, the less milk they drink. Milk provides calcium, protein and vitamins that help your body function well, but soda and juice drinks provide a lot of calories from sugar and little to no nutritional value.
To avoid excess added sugar, you should know what foods and drinks are highest in added sugar. Sugary drinks, including soft drinks, sports drinks and fruit drinks, are the number 1 source of added sugar in the American diet. A 12-ounce can of non-diet (regular) soda can contain 8 or more teaspoons of sugar and over 130 calories. That’s more sugar than the American Heart Association recommends for an average American woman in 1 day!
That copy may sound good on the surface, but I notice a couple of subtle issues with this section’s language that could be interpreted as reflecting the influence of a soft drink company. Notice, for example, how “fruit drinks” (they’re called “juice drinks” in the earlier paragraph) are included in the list of “sugary drinks” that “are the number 1 source of added sugar in the American diet.” A non-discerning consumer might confuse “fruit drinks” with “fruit juices.” The latter do contain natural sugars, but not added ones — and they are certainly not even close to the top of the list of food products that are contributing to our obesity epidemic.
By confusing this issue, is this content impeding the ability of consumers to choose more healthful alternatives to soft drinks?
Notice also the emphasis on “non-diet (regular)” soda. There is no mention of research showing that diet soda has also been linked to obesity (and diabetes and heart disease).
In fact, under the section “Healthy Living: How Common Behaviors Affect Your Health,” FamilyDoctor.org actually suggests that people who want to watch their weight should consider switching to diet soda. Note also that in this section, “fruit juice” (not even “fruit drinks” or “juice drinks”) suddenly leads the list of “sugar-sweetened drinks”:
Sugar-sweetened drinks, such as fruit juice, fruit drinks, regular soft drinks, sports drinks, energy drinks, sweetened or flavored milk and sweetened iced tea can add lots of sugar and calories to your diet. But staying hydrated is important for good health. Substitute water, zero-calorie flavored water, non-fat or reduced-fat milk, unsweetened tea or diet soda for sweetened drinks. Talk with your family doctor or a dietitian if you have questions about your diet or healthy eating for your family.
No corporate influence? Maybe not.
But this could be a case of the dog that didn’t bark.