US: Is Fast Food Just What the Doctor Ordered?

For
the last 28 years, Dr. Dean Ornish has been trying to persuade people
to eat healthier. In his five books, he champions low-fat diets; he was
one of the first researchers to show that stringent healthy eating can
reverse chronic illness, particularly heart disease. Among his advice
to patients is to eat a lot of vegetables and minimally processed
foods, and avoid all things greasy.

Dr. Ornish also works for the McDonald's Corporation.
As a paid consultant, he meets with top executives, gives talks to
employees and recently wrote nutritional words of wisdom about diet and
breast cancer for table displays to go into all McDonald's restaurants
in the United States for Mother's Day.

He is not the only one straddling this line between science and
commerce. In the last two years, at least two dozen leading nutrition
scientists and experts have started working for large food companies,
either as consultants or as members of health advisory boards. Most do
not directly promote products, though Dr. Arthur Agatston, a practicing
cardiologist and author of "The South Beach Diet," has a licensing deal
with Kraft Foods to sell a line of South Beach foods, which are appearing on supermarket shelves this month.

As concerns mount over the nation's elevated obesity rates and the
surge in diet-related illnesses, food companies have received
heightened scrutiny from Congress and face threats of litigation from
trial lawyers. In response, companies have fashioned "health and
wellness" initiatives. And companies like McDonald's, Kraft, PepsiCo and the Coca-Cola Company have created advisory boards, putting people who might otherwise be critics on the payroll.

Their dual roles have created a deep divide in the scientific
community. Some critics say that working for a large food company
compromises the credibility of scientists' research and makes them look
like part-time company representatives. They say advisory boards and
tacit endorsements from health gurus do more to make companies look
good and help them sell products than inspire change.

"These companies can say we have all these really important people
who care about health working with us, and that takes some of the heat
off," said Marion Nestle, a nutrition professor at New York University.
"But all they're doing is making junk food marginally healthier."

But scientists working for the food companies say they hope to improve the American diet from within.

Dr. Ornish, who is president and director of the Preventive Medicine
Research Institute, which is based in Sausalito, Calif., and studies
the effects of diet and lifestyle choices on health and disease, says
he wants to help McDonald's become a healthier company, a place that
one day will sell a lot more of the kind of food he counsels people to
eat. He won't say how much McDonald's pays him, but he says the money
is not why he's doing it.

"A lot of colleagues were puzzled at first by my decision, but now
they see it as a logical extension of what I've been doing my whole
career," said Dr. Ornish, who also works for PepsiCo and ConAgra Foods. "It's an amazing platform to make a difference."

Sometimes a scientist's name appears on a food package. Health tips
from the fitness expert Dr. Kenneth H. Cooper appear on packages of
Frito-Lay's baked snack chips, for example, with his name attached.
Other times a scientist appears in marketing material: a photo of Dr.
John P. Foreyt, a researcher on heart disease at the Baylor College of
Medicine in Houston, is in a Coca-Cola ad in magazines like Good
Housekeeping this month.

Dr. Agatston, who is an associate professor at the University of
Miami School of Medicine, says he decided against appearing in ads for
Kraft. Instead, the South Beach logo appears in large type on two dozen
products.

One medical specialist recruited to a food company advisory board
has already decided that membership was not worth the cost. Dr. George
L. Blackburn, director of the Center for the Study of Nutrition
Medicine at Harvard Medical School and a prominent researcher on
obesity issues, decided to step down from a McDonald's advisory council
on balanced lifestyles two months ago.

In an interview, he said he left because he was disappointed that
McDonald's had not incorporated his recommendations into its recent
"Balanced Lifestyles" campaign. "Our message here at the center is
threefold: cut the calories, eat quality food and exercise," said Dr.
Blackburn. "The first two messages weren't making it through."

McDonald's new worldwide health education campaign, introduced last
month, focuses largely on exercise, with little discussion of diet. "If
I were on the exercise side, I'd be ecstatic," said Dr. Blackburn. "But
I'm focused on the role of food in a healthy lifestyle. Every scientist
knows that increasing exercise is not going to replace cutting the
calories."

McDonald's executives said that they were surprised by Dr.
Blackburn's resignation, and that they were committed to changing the
company's menu and encouraging better nutrition habits among customers.

Other members of McDonald's advisory council say they are willing to
be more patient. "I feel like we're being slowly yet consistently
effective," said Dr. Dennis M. Bier, director of the Children's
Research Center at Baylor College of Medicine and a member of the
McDonald's council. "McDonald's is such a big company that it takes
longer to have changes implemented."

Dr. Bier said he and other council members were involved in
encouraging McDonald's to add fruits and vegetables - premium salads,
apple dippers and other items on the way - to the menu.

Dr. Cooper, who runs the Cooper Institute, a preventive medicine
organization in Dallas, also said he thought his work with PepsiCo over
the last three years had had a meaningful impact. A tall, energetic
72-year-old, Dr. Cooper said he was instrumental in getting the company
to remove trans fats - a substance found in chemically modified
vegetable oils that is believed to increase cholesterol levels - from
its snack chips and to introduce baked potato chips. Now, he says, he
is prodding the company to use low-fat cheese for snacks like Cheetos
and Doritos.

Dr. Cooper, who is also a medical adviser to President Bush, says he
and the other members of PepsiCo's advisory board do not hold back
their criticisms. Currently, he says, the board is trying to prevent
the company from putting a SmartSpot label on its line of light chips,
which contain olestra, a fake fat that once had to carry a warning
label about unpleasant gastrointestinal side effects. The SmartSpot
designation identifies products that PepsiCo has determined to be
healthy choices.

"Unless I get some good data that shows benefits and no harm, I
would not allow that," Dr. Cooper said. "Pepsi listens very carefully
to us and follows our recommendations."

Pepsi's health board gathers in person four times a year, Kraft's
three times. Coke's and McDonald's both meet twice a year. Fees paid to
the specialists often are closely guarded secrets. Kraft, Coke and
Pepsi would not say how much their advisers and consultants were paid.
McDonald's was more forthcoming and said its board members receive an
annual fee of $7,500.

Like Dr. Ornish, Dr. Cooper declined to talk about the compensation
he receives as a consultant. Dr. Agatston said he would receive
royalties based on sales of South Beach products, which include
whole-wheat frozen pizza, several varieties of whole-grain cereal and
frozen dinners with minimal saturated fat.

Some scientists say any amount of money received is too much and has
the potential to create the appearance of a conflict of interest. Dr.
Walter Willett, chairman of the Department of Nutrition at the Harvard
School of Public Health, says he has turned down a variety of offers
from food companies because accepting would compromise his research.

"It's particularly an issue if we come out and say some food has no
problems and I'm on one of their boards," said Dr. Willett, an
epidemiologist who is involved in the large, continuing nurses' health
study. "People would wonder whether we were really biased or not."

Dr. David Ludwig, director of the childhood obesity program at
Children's Hospital in Boston, has also turned down paid consulting
offers and says he has ruled out being on a company's advisory board,
even unpaid. "If Coca-Cola were interested in my thoughts about how it
could design more healthful products, I would be delighted to offer my
opinion to them," said Dr. Ludwig. "But I won't accept money in return,
nor will I accept a seat on their advisory board. I think it implies
that you are representing the interests of the company."

Some of Dr. Ludwig's work includes findings that are not exactly
good news for food companies, such as those correlating fast-food
consumption with weight gain and sugar-sweetened beverages with a
higher risk of Type 2 diabetes, the kind associated with obesity, in
women.

Dr. Ornish argues that detractors don't give food companies enough
credit. "It's very easy to be a purist and demonize things, but as I
get older I realize that life is shades of gray," he said recently.
"Are these companies moving as quickly as I might like? Of course not.
But they're moving much faster than I ever thought possible."

• 182 Health
• 188 Consumerism & Commercialism