International Journal of Environmental Research and Public Health, 2020
No studies have documented the prevalence of the food industry’s funding of academic programs, wh... more No studies have documented the prevalence of the food industry’s funding of academic programs, which is problematic because such funding can create conflicts of interest in research and clinical practice. We aimed to quantify the publicly available information on the food industry’s donations to academic programs by documenting the amount of donations given over time, categorizing the types of academic programs that receive food industry donations, cataloguing the source of the donation information, and identifying any stated reasons for donations. Researchers cataloged online data from publicly available sources (e.g., official press releases, news articles, tax documents) on the food industry’s donations to academic programs from 2000 to 2016. Companies included 26 food and beverage corporations from the 2016 Fortune 500 list in the United States. Researchers recorded the: (1) monetary value of the donations; (2) years the donations were distributed; (3) the name and type of recip...
Conditions related to nutrition are commonly seen in clinical practice, yet few physicians have t... more Conditions related to nutrition are commonly seen in clinical practice, yet few physicians have the knowledge, experience, or time todiscusshowpatients’ diets affect their health. Over the last half century, many individuals andgroups have called formore andbetter nutrition instruction duringmedical education. Themost recent plea is in this issue of JAMA Internal Medicine. Nathaniel Morris,1 a student at HarvardMedical School, is acutely awareof the importanceofdiet inpreventingandtreatingchronicdiseasesand isuneasyabout the limited trainingheandhis classmates are getting tohandle the dietary problems of so many of his future patients. “As a medical student,”Morris writes, “I cannot fathomwhymedical schools continue to neglect nutrition education.”1 Our reaction to MrMorris’s justifiable complaint is a profoundsenseofdejavu.Asparticipants inearlyattempts tobring nutrition education into medical training, we share his frustration. Nonetheless, we think we can explain why nutrition has been so long neglected and why now is such a good time to raise this issue again. Medical education is changing rapidly to bettermeet the needs of patients; attention to the role of diet in health—and the skills needed by physicians to help patients improve theirdiets—arenecessarycomponentsof that change. We are optimistic that desirable curriculum changes can at last be achieved. Our interest in this issue startednearly 40years ago,when we were both at the University of California, San Francisco (UCSF), SchoolofMedicine. In 1976, oneofus (R.B.B.)was, like MrMorris, amedical student advocating for nutrition instruction, while the other (M.N.) was a lecturer newly recruited to provide that instruction. For the next decade, we worked together to create “NutritionUCSF,” a comprehensiveprogramof nutrition training that at its peakencompassed 16hoursofpreclinical instruction; regular lectures and ward rounds in several clinical rotations; an intensive, 1-month fourth-year clinical elective; anongoing lecture series for thehealthprofessions community; andpostgraduate continuing education courses.2 In addition to our youthful interest and enthusiasm, we were able to achieve all this for a simple reason:we had funding. Funding came first froma curriculumdevelopment grant fromtheHealthResourcesAdministrationand later fromaprivate foundation. These grants allowed us to pay faculty for a small portion of their time and leverage nutrition hours into thecurriculum.When thegrants endedandwemovedonwith our careers, the nutrition hours were reduced. After a hiatus and a major reform of the entire curriculum,3 nutrition has againbecomean importantpart ofmedical educationatUCSF. Lack of funding and of trained and interested faculty are critical reasonshigh-qualitynutrition instructionhasbeenabsent frommedical education, thenandnow.Other reasons are (1) thebeliefsof somefacultymembersandadministrators that nutrition is insufficiently science-based for rigorous medical education; (2) the lack of a department-based administrative home; and (3) the focus ofmedical training on treating rather than preventing diseases. Together, these formidable barriers lead to the serious “mismatch between the skills of physicians and the needs of patients” that Morris has found.1 Morris cites the latestmedical school survey findings: only 25% of US medical schools offer a dedicated course on nutrition, and the average number of contact hours devoted to nutrition instruction over 4 years ofmedical school is 19.6.4 Dismal as these figures appear to be, however, we think they are the wrong metric. No matter howmany hours of lectures are devoted to specific nutrition topics, the information will not “stick” unless reinforced in daily patient care. The real barrier tonutrition training, thenandnow, is the lackof reinforcement of nutrition principles during the clinical years, residency training, and medical practice. This problem, of course, is not limited to nutrition; it applies to all of current medical training. Efforts are ongoing to transform medical education from course-based didactic instruction to competency-based learning inhealth care teams. These efforts offer the opportunity to teachmedical students about dietary problems in the clinical and outpatient settings in which such issues arise and can best be addressed. In its 2010 study of innovations and challenges inmedical education, the Carnegie Foundation for the Advancement of Teaching5 observed that clinical training still emphasizes facts andinpatientexperience, thatclinical facultyhavetoolittle time to teach, and thathospitals find it increasinglydifficult to support teaching.Preclinical instruction, thestudy found,pays too little attention to experiential learning, patient characteristics,patientsafety,andquality improvement.Furthermore,neitherpreclinicalnorclinical trainingsufficientlyemphasizes the needforphysicians tobecomeadvocates forappropriatehealth care, their patients, and fundamental values…
Should clinicians prescribe fat-controlled diets to prevent coronary heart disease (CHD), and, if... more Should clinicians prescribe fat-controlled diets to prevent coronary heart disease (CHD), and, if so, which patients should be given this advice? In this report, we use a three-step model to explain the hypothesis that dietary fats are a cause of CHD: dietary saturated fat and cholesterol raise serum cholesterol levels (step 1), which are a cause of subclinical coronary atherosclerosis (step 2), and, in turn, clinically manifest CHD (step 3). An evaluation of the scientific evidence for each step leads us to conclude that dietary fats definitely influence the level of serum cholesterol, and that serum cholesterol is probably a cause of atherosclerosis and CHD. To determine the clinical implications, we examined the potential of various foods to keep cholesterol levels lower, as well as the projected magnitude of reduction in CHD risk. The likelihood of benefit varies among patients, ranging from uncertain or trivial (for those with lower serum cholesterol levels, those who are free ...
Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption... more Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption pattern based largely on grains, fruit and vegetables, with smaller amounts of meat and dairy foods, and even smaller amounts of foods high in fat and sugar. Such diets are demonstrably health promoting, but following them raises ethical issues related to the role of nutritionists in advising the public about healthful dietary choices, as well as to the role of the food industry in food production and marketing. In the USA a shift towards a more plant-based diet would affect the economic interests of producers of food commodities, food products and meals prepared outside the home; it would also affect the environment, food prices, trade with other countries (developing as well as industrialized) and relationships among the food industry, government agencies (domestic and international) and food and nutrition professionals. In a free-market economy any dietary choice has consequences for...
International Journal of Environmental Research and Public Health, 2020
No studies have documented the prevalence of the food industry’s funding of academic programs, wh... more No studies have documented the prevalence of the food industry’s funding of academic programs, which is problematic because such funding can create conflicts of interest in research and clinical practice. We aimed to quantify the publicly available information on the food industry’s donations to academic programs by documenting the amount of donations given over time, categorizing the types of academic programs that receive food industry donations, cataloguing the source of the donation information, and identifying any stated reasons for donations. Researchers cataloged online data from publicly available sources (e.g., official press releases, news articles, tax documents) on the food industry’s donations to academic programs from 2000 to 2016. Companies included 26 food and beverage corporations from the 2016 Fortune 500 list in the United States. Researchers recorded the: (1) monetary value of the donations; (2) years the donations were distributed; (3) the name and type of recip...
Conditions related to nutrition are commonly seen in clinical practice, yet few physicians have t... more Conditions related to nutrition are commonly seen in clinical practice, yet few physicians have the knowledge, experience, or time todiscusshowpatients’ diets affect their health. Over the last half century, many individuals andgroups have called formore andbetter nutrition instruction duringmedical education. Themost recent plea is in this issue of JAMA Internal Medicine. Nathaniel Morris,1 a student at HarvardMedical School, is acutely awareof the importanceofdiet inpreventingandtreatingchronicdiseasesand isuneasyabout the limited trainingheandhis classmates are getting tohandle the dietary problems of so many of his future patients. “As a medical student,”Morris writes, “I cannot fathomwhymedical schools continue to neglect nutrition education.”1 Our reaction to MrMorris’s justifiable complaint is a profoundsenseofdejavu.Asparticipants inearlyattempts tobring nutrition education into medical training, we share his frustration. Nonetheless, we think we can explain why nutrition has been so long neglected and why now is such a good time to raise this issue again. Medical education is changing rapidly to bettermeet the needs of patients; attention to the role of diet in health—and the skills needed by physicians to help patients improve theirdiets—arenecessarycomponentsof that change. We are optimistic that desirable curriculum changes can at last be achieved. Our interest in this issue startednearly 40years ago,when we were both at the University of California, San Francisco (UCSF), SchoolofMedicine. In 1976, oneofus (R.B.B.)was, like MrMorris, amedical student advocating for nutrition instruction, while the other (M.N.) was a lecturer newly recruited to provide that instruction. For the next decade, we worked together to create “NutritionUCSF,” a comprehensiveprogramof nutrition training that at its peakencompassed 16hoursofpreclinical instruction; regular lectures and ward rounds in several clinical rotations; an intensive, 1-month fourth-year clinical elective; anongoing lecture series for thehealthprofessions community; andpostgraduate continuing education courses.2 In addition to our youthful interest and enthusiasm, we were able to achieve all this for a simple reason:we had funding. Funding came first froma curriculumdevelopment grant fromtheHealthResourcesAdministrationand later fromaprivate foundation. These grants allowed us to pay faculty for a small portion of their time and leverage nutrition hours into thecurriculum.When thegrants endedandwemovedonwith our careers, the nutrition hours were reduced. After a hiatus and a major reform of the entire curriculum,3 nutrition has againbecomean importantpart ofmedical educationatUCSF. Lack of funding and of trained and interested faculty are critical reasonshigh-qualitynutrition instructionhasbeenabsent frommedical education, thenandnow.Other reasons are (1) thebeliefsof somefacultymembersandadministrators that nutrition is insufficiently science-based for rigorous medical education; (2) the lack of a department-based administrative home; and (3) the focus ofmedical training on treating rather than preventing diseases. Together, these formidable barriers lead to the serious “mismatch between the skills of physicians and the needs of patients” that Morris has found.1 Morris cites the latestmedical school survey findings: only 25% of US medical schools offer a dedicated course on nutrition, and the average number of contact hours devoted to nutrition instruction over 4 years ofmedical school is 19.6.4 Dismal as these figures appear to be, however, we think they are the wrong metric. No matter howmany hours of lectures are devoted to specific nutrition topics, the information will not “stick” unless reinforced in daily patient care. The real barrier tonutrition training, thenandnow, is the lackof reinforcement of nutrition principles during the clinical years, residency training, and medical practice. This problem, of course, is not limited to nutrition; it applies to all of current medical training. Efforts are ongoing to transform medical education from course-based didactic instruction to competency-based learning inhealth care teams. These efforts offer the opportunity to teachmedical students about dietary problems in the clinical and outpatient settings in which such issues arise and can best be addressed. In its 2010 study of innovations and challenges inmedical education, the Carnegie Foundation for the Advancement of Teaching5 observed that clinical training still emphasizes facts andinpatientexperience, thatclinical facultyhavetoolittle time to teach, and thathospitals find it increasinglydifficult to support teaching.Preclinical instruction, thestudy found,pays too little attention to experiential learning, patient characteristics,patientsafety,andquality improvement.Furthermore,neitherpreclinicalnorclinical trainingsufficientlyemphasizes the needforphysicians tobecomeadvocates forappropriatehealth care, their patients, and fundamental values…
Should clinicians prescribe fat-controlled diets to prevent coronary heart disease (CHD), and, if... more Should clinicians prescribe fat-controlled diets to prevent coronary heart disease (CHD), and, if so, which patients should be given this advice? In this report, we use a three-step model to explain the hypothesis that dietary fats are a cause of CHD: dietary saturated fat and cholesterol raise serum cholesterol levels (step 1), which are a cause of subclinical coronary atherosclerosis (step 2), and, in turn, clinically manifest CHD (step 3). An evaluation of the scientific evidence for each step leads us to conclude that dietary fats definitely influence the level of serum cholesterol, and that serum cholesterol is probably a cause of atherosclerosis and CHD. To determine the clinical implications, we examined the potential of various foods to keep cholesterol levels lower, as well as the projected magnitude of reduction in CHD risk. The likelihood of benefit varies among patients, ranging from uncertain or trivial (for those with lower serum cholesterol levels, those who are free ...
Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption... more Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption pattern based largely on grains, fruit and vegetables, with smaller amounts of meat and dairy foods, and even smaller amounts of foods high in fat and sugar. Such diets are demonstrably health promoting, but following them raises ethical issues related to the role of nutritionists in advising the public about healthful dietary choices, as well as to the role of the food industry in food production and marketing. In the USA a shift towards a more plant-based diet would affect the economic interests of producers of food commodities, food products and meals prepared outside the home; it would also affect the environment, food prices, trade with other countries (developing as well as industrialized) and relationships among the food industry, government agencies (domestic and international) and food and nutrition professionals. In a free-market economy any dietary choice has consequences for...
Uploads
Papers