Lawrence and Germov chapter overview

Functional foods refer to the notion that some foods are beneficial for one's health; they can promote health and prevent disease -- such as for instance yogurts that contain probiotic organisms that are claimed to be disease-preventing or margarines with phytosoterols that are alleged to help improve immunity. These food products are marketed as health-promoting or disease-reducing foods on the alleged basis of so-called scientific research that has been conducted to 'conclusively' demonstrate these claims. On the other hand, some scientists are skeptical of such claims observing that marketing of such foods helps stakeholders by bringing in billions of dollars and that their assumptions (publicized by health claims that appear on the product) are over simplistic and deceptive to an easily duped consumer. In fact, marketing analysts have oft noted the association between a health claim on the product and the consequent increase in sales. Many examples of food products, such as grape juice and breakfast cereal, when having added a health claim have dramatically increased their sales. The following five discussion questions deal with matters related to these claims, investigate the key stakeholders responsible in the matter, discuss how government can protect public health and safety whilst managing the introduction of function foods, analyze the respective roles of the public and private sector in nutrition education, and, finally, examine the impact of the introduction of functional foods and health claims.

1. What implications, both positive and negative, for public heath nutrition do functional foods present?

There are two contradictory paradigms in the debate on public health nutrition. The first, proposed by "The Giessen Declaration" (2005) proposed a holistic foundation towards nutrition that was defined as:

The study of food systems, foods and drinks, and their nutrients and other constituents and of their interactions within and between all relevant biological, social and environmental systems. The purpose of nutrition science is to contribute to a world in which present and future generations fulfill their human potential, live in the best of health, and develop, sustain and enjoy an increasingly diverse human, living, and physical environment (Lawrence & Gerrnov, * p.155).

In other words, healthy living consists of the interaction between social, economic and cultural factors. People with lower socioeconomic conditions suffer a disproportionate burden of disease, the priority objective, therefore, should be to ensure equal access to affordable, nutritious, and safe food.

Molecular nutrition, on the other hand, of which functional foods is an outcome, is reductive in characteristic. It reduces an individual's health and composition to molecular, cellular, and genomic mechanisms. Some scientists claim that genetic variants, for instance, could be responsible for all types of diseases such as obesity, diabetes, and heart disease. In this way, the functional food issue steps in with its claim that it can reduce if not prevent such disease from occurring due to inherently healthy characteristics in the food that it promotes.

The problem is that these claims are not only likely duping a public who would pay any amount of money to spare themselves from these diseases, but they are also disseminating false science, and preventing government and non-government institutions from disseminating their resources and attention to the factors that really need them: the causative social, economic, and cultural factors.

The reality with functional foods is that they have shown little positive impact on diet-related disease (Lawrence & Gerrnov, *). Their danger lies in the fact that the public will come to rely on them (as indeed often happens) as instrumental for eradicating or preventing the disease when such is, in reality, not the case. Whilst they can be advantageous when medically prescribed as part of a therapeutic diet, over reliance and false claims can make them harmful. In short, as Lawrence and Gerrnov,( *) conclude:

The potential benefits of functional foods need to be kept in perspective; whilst some functional foods may provide health benefits for some people in some circumstances, overall they present social, environmental, and public safety challenges. (168).

2. Who are the key stakeholders in the functional foods debate and what are their respective views?

Key stakeholders (otherwise known as actors or players) may be divided into five categories: (1) elected officials; (2) appointed officials; (3) interest groups; (4) research organizations, and (5) the mass media.

Their respective views are usually commercial: they gain some monetary profit from promoting the product such as the endorsement of folic acid or the National Health Foundation endorsement of McDonalds's meals (Lawrence & Gerrnov, p.162). In fact, Lawrence and Gerrnov (*) point out that if government authorities, for instance, were really concerned about the role of food in health, they would not only promote the health value of certain foods but also consider 'disease' claims; on food products. That the reverse is the case indicates that promoting food is a lucrative industry.

That such is the case can be seen by instances of egregious cases studies provided by Lawrence and Gerrnov (*). Folic acid, for instance, is a vitamin that is pressed on the pregnant mother by most medical and nursing associations. Doing so is based on the evidence that an increase in a mother's folic acid intake may increase the possibility of preventing neural tube defects. However what is not well-known is that there are significant shortfalls in this research: firstly the fact that there is much about NTD that is not known nor well-understood; secondly, that a significant proportion of pregnancies are unplanned; and, thirdly, that the neural tube closes at approximately the end of the fourth week after conception, well before most women are taking folic acid. Yet the folate-NTD health claim is still hailed as being a significant discovery, and every pregnant woman is told to go to the pharmacy and procure the drug.

One more example given here is the National Heart Foundations' (NHF) 'Tick Program' that enabled food manufacturers to display the Tick symbol on their product once they had submitted the product to the NFH for approval and had paid the required license fee. What was not known was that this 'Tick Program' was linked to McDonalds' restaurants. In early 2007, McDonald's Australia announced that it had paid the NHF a license fee of $330,000 in return for endorsing nine 'Tick-approved' meals at its restaurants. Each of these meals endorsed were, when investigated, unhealthy and totally contrary to well-known claims for promoting a healthy heart diet (for instance, they contained high fat, salt and sugar).

There is undoubted evidence that research may be rigged. In her book "Food politics" (2002), for instance, Marion Nestle recounts how Proctor and Gamble Manufacturers presented the U.S. Food and Drug Administration with rigged research findings done by biased non-independent researchers to support claims of Olestra (a synthetic food substitute that may be added to foods such as potato chips).

The levels of evidence used by Food Standards to verify alleged 'functionality' of foods include (in the order given):

Systematic reviews of scientifically controlled randomized studies

Properly-designed randomized studies, or quasi-experimental trials

Cohort studies

Case-control studies

Comparative studies with a historical context or case-series, and Other relevant information such as reports from appropriate specialists

It is often thought that scientific research is infallible and beyond dispute. The contrary, however, may unfortunately be true. Truswell (2001) points out that randomized controls, for instance, can be poor when the study is small or when there is no independent confirmation of the experimental food that was changed. Another category of study, although grouped lower on the pyramid may be more reliable in its outcome. Evidence may be biased, confounded, or unwittingly or deliberately distorted, and the organization in charge of determining Food Standards may not always be aware of the shortcomings in the experimental trial.

In short, key stakeholders in the functional foods-health claims are food manufacturers, pharmaceutical companies, and some medical scientists and government agencies. Impetus for governmental support is potential economic gain, as well as export dollars that functional foods may well usher into the country, and alleged long-term savings in health care costs. These stakeholders, as per Lawrence and Gerrnov (*), constitute a new "medical food -- industrial complex" (p.164).

3. How can government protect public health and safety whilst managing the introduction of functional foods?

Government can establish a strong regulatory framework that demands that well-established and objective scientific research be conducted on a food in order to support its alleged claims as being functional. Public health and safety should be their first priority, and this could be assured by substantiating allegations and by ensuring that claims are not misleading to consumers.

Certainly making policies regarding foods that are termed 'functional' and regarding impeding companies from making corrupt claims would be helpful. Here could be employed the Bridgeman and David model, namely:

a. Identifying issues

2. Consultations

3. Implementation

4. Monitoring and evaluation

In a practical sense, the whole process is done in a win-win format where the relevant groups are involved. As Bridgman and Davis (2002) define it, the consultation process is one that "seeks to solicit and respond to views about a policy proposal from relevant people and groups" (p.18). In this manner, the public and private sectors can ascertain that via reflection and debate, the appropriate issues are addressed, the product is truly what it is with no erroneous and misleading claims attached, and that consultation will be implemented in a manner equitable to all. This was the way, for instance that Pollard et al. (2001) and Roos et al. (2002) implemented food and nutrition policy schemes at the local, state, and national levels, for instance, in the case of Pollard et al. (2001), in child care centers.

Questions that involved in policy evaluation include:

Have the stated goals and performance indicators of the policy been achieved -- for instance, is corruption impeded and all foods truly styled for what they are including their potential negatives?

Are there changes in the area that the policy was supposed to be influencing?

Has the policy really caused the claimed change or are other factors involved?

Was the policy cost-effective?

The entire process of policy construction and policy evaluation is one that may be conducted between different sectors in the private sectors, or preferably one that is leveraged by public sectors against the private sector with an involved campaign for government support.

4. What do you think should be the respective roles of the public and private sectors in nutrition education, monitoring and evaluation of functional foods?

The public can also teach awareness regarding interests that are involved in manufacturing food. Critical awareness of the issues involved is crucial.

Understanding the role that language plays is helpful. Facts become malleable through language and take on different forms. Performative language seduces and persuades creating a miasma when none existed. An understanding of the concept of social constructionism (how language can be employed to describe the same thing in various ways) and marketing manipulation helps. Thought, too, can be accorded to the fact that assumptions about certain factors repeated often and vigorously enough soon become accepted as 'truth' and 'fact' (Cummins & McIntyre, 2002). All assertions, therefore, have to be thoroughly investigated, howsoever convinced we may be about their truth-value.

Parsons (1995) postulates four types of questions that can be asked as a way of critically evaluating 'knowledge' and 'evidence':

1. Whose knowledge is being used? Who, for instance, funded the research and how is propagating (or advertising) this food?

2. What kind of knowledge does it claim to be? Is it scientific or objective? What kind of experts are involved? What sort of ideology underpins the information?

3. Is the 'knowledge' or 'evidence' so simply because a given construct of social values exist right now at this given period?

4. How is knowledge used in the policy process? How is this knowledge propagated and how does it impact on public opinion?

As Lang (1997) shows, a concerned public can certainly influence food policy if it wishes to. During the 1980s and early 1990s in Britain, for instance, food campaigns organized by non-government organizations played a key role in generating interest in food policy. The way that they did this can be of help to us in our own discussion about how to fight possible malingering in the 'functional' food factor. NGO's campaigned in two ways: firstly, they created alliances between middle-class people, politicians, scientists, activists, and anyone interested in the food movement. Secondly, they instituted an organized voice in their policy making and then followed that policy making with vigilance focused on the actions of government and the food industry. They also made sure that the public and government were aware of the fact that the food policy debate was not as much on health (as was originally thought) as it was concerned with market-driven interests. It is in this way that private sectors (or NGO's) working together can influence government and private corporations or sector, and have a significant impact on food policy debates.

Finally, the media is an important factor in the construction of public awareness regarding the problem. As witnessed with the outbreak of the 'mad cow' disease in Europe, the media capitalized on this theme since it knew it would cater to public interest. The media in this way can act as 'gatekeepers' by blocking certain news from reaching the public and only allowing news that it considers newsworthy to enter.

The obesity epidemic is another noteworthy example. The media finds the problem, fascinating, it exaggerates the issue, and the scientific community abets the hype by providing further research outcomes, which again is employed by the media to sensationalize the issue.