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if you've been following along with our daily food

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vlogs, you've seen that I've been adding this to

1:00

my water in the morning. Celery

1:02

acts as a diuretic, neutralizes

1:04

body acidity and helps me... There's a

1:06

lot about how to diet and lose weight,

1:09

but there is also pushback to all that

1:11

advice. We tend to have

1:13

such binary thinking when it comes to

1:15

food. We only have two categories in

1:17

our minds, good and bad, with nothing in

1:19

between. That culture really

1:21

teaches us that nourishment comes from a certain

1:24

type of food. There's

1:26

a much gentler way to change

1:29

what you're eating, to change how

1:31

your body feels without using those

1:33

nasty words should and shouldn't, can't

1:36

and cannot. Well now a

1:38

new investigation by the Washington Post has

1:40

found that the food industry is also

1:42

embracing some of this anti-diet messaging for

1:44

its own purposes. That industry is lobbying

1:47

dietician influencers and in some cases, sponsoring

1:49

their content on social media. As

1:51

part of our series on wellness, well-founded,

1:53

I'm joined by Caitlin Gilbert, data reporter

1:55

with the Washington Post. Caitlin, good morning.

1:58

Good morning, Matt. Why did you want to look into

2:00

this? this, the anti-diet messages on social media. This

2:03

was something we stumbled on from our

2:05

first investigation. We were looking at online

2:08

dieticians on social media. We noticed that

2:10

a lot of the content was falling

2:12

under this umbrella of folks talking about

2:14

things like intuitive eating, health at every

2:17

size, general anti-diet ideas. It was something

2:19

we were definitely interested in kind of following up

2:21

on further. And so when

2:23

we started reporting a bit more, we heard

2:25

from other dieticians, many of whom were

2:27

not online. And then additionally

2:30

hearing a lot of those messages being

2:32

echoed by companies like General

2:34

Mills being used to promote their products and

2:36

push back against regulation. So that was sort

2:38

of the impetus. We heard some of the

2:41

examples there, but can you explain a little

2:43

bit more about how this –

2:45

what we're calling anti-diet messaging plays out on TikTok

2:47

and Instagram? What are the things that are being

2:49

said? We did a more kind

2:51

of a comprehensive look at this because this was

2:54

newer to us as well as reporters. We looked

2:56

at folks using different hashtags like intuitive

2:58

eating, like anti-diet, like health at every

3:00

size. A lot of these things sometimes

3:02

are used interchangeably, sometimes are used more

3:05

specifically. But broadly, right, people are

3:07

talking about kind of resisting a

3:09

lot of the really toxic fad

3:11

diets, diet culture more broadly, the

3:13

sort of obsession with thinness, unhealthy

3:15

weight stigma. A lot of the

3:17

anti-diet movement centers a more healthy relationship

3:19

with food. And so that was sort

3:21

of the broad kind of theme we

3:24

were seeing. And then when we took

3:26

a look at those posts, a lot

3:28

of people were experiencing various ranges of

3:30

things, right, like really severe eating disorders,

3:32

talking about their experiences with those things,

3:35

talking about severe diets, experiences with

3:37

weight loss and struggles with weight loss, and

3:39

how they were kind of growing out of

3:41

those experiences. But at the

3:43

same time, we noticed that some

3:45

folks were also saying essentially that

3:48

chronic diseases like things like diabetes

3:50

and fatty liver, kidney disease couldn't

3:52

be caused by nutritional choices and sort

3:54

of removing that connection entirely. That was something

3:56

dieticians had come to us and said they

3:58

were concerned about. how extreme some

4:00

of the messaging, particularly on social media, was

4:03

getting. When you talked about hashtags on social

4:05

media, I mean one of them is Derail

4:07

the Shame. And the shame is about feeling

4:09

bad about what you eat, right? Yes.

4:11

So Derail the Shame is something that

4:14

people sort of are generally using to

4:16

talk about removing shame around food and

4:18

shame around eating different types of food,

4:20

but we also saw that hashtag specifically

4:23

being used by General Mills

4:25

in their presentation of what

4:27

they were calling novel food shame research and looking

4:29

at the effects of food shame. And so at

4:32

big conferences like FinC, where lots

4:34

of dietitians attend, nutritionists attend, this

4:37

was the language that they were also

4:39

using. What was happening at that conference and what's

4:41

the role of the food industry in helping to

4:43

shape the conversation? Because the conference plays a huge

4:45

part in this, right? Yeah, so

4:47

FinC is this annual conference, very,

4:49

very large conference around nutrition

4:51

generally. The Academy of Dietetics and

4:53

Nutrition sponsors this conference every year

4:56

and many, many different

4:58

food companies show up at FinC every year in

5:00

a sort of like expo style floor

5:02

events. And General Mills was actually having

5:05

a really large session specifically to

5:07

debut this novel food shaming research

5:09

where they essentially talked about how

5:11

they conducted a survey where they were

5:13

saying that food shaming was sort of

5:15

the root of all kinds of various

5:18

problems in the American society and they

5:20

even kind of made that link to

5:22

regulation around food. And so this was

5:24

sort of like the first indication to

5:26

us that the food industry was doing

5:28

something around co-opting this language. And we

5:30

saw this again and again with big

5:33

food companies using that language

5:35

to push back against regulation. On

5:37

top of that, you know, General Mills has hired

5:39

a kind of lobbyist, spent millions of dollars to

5:42

push back against any kind of regulation, notably

5:44

the kind of labeling around foods. So even

5:47

something like, you know, the current version

5:49

suggests putting labels that would say that

5:51

a food is high in added sugars

5:53

or a food is high in sodium

5:55

or a food is high in saturated fats,

5:57

which are kind of the common categories the FDA

5:59

is interested in. interested in labeling. They would call

6:01

that food shaming from General Mills' perspective. And

6:03

so this is where we were starting to

6:05

get concerned about how messages that might

6:07

be really helpful for folks online are now being co-opted

6:10

for a for-profit purpose. What's the relationship

6:12

between General Mills? And you talk a

6:14

lot about General Mills and those influencers

6:17

online. So General Mills has

6:19

sort of done kind of a

6:21

multi-pronged approach to this. So

6:23

they obviously at these conferences are interfacing

6:25

directly with dieticians. We found that they've

6:28

given personalized gifts to some dieticians. So

6:30

you'll see some of this on social

6:32

media under that Derail the Shame

6:35

hashtag where dieticians will share kind

6:37

of personalized Cheerios boxes or cereal

6:39

boxes with their names on it. And then

6:41

they're parroting that language that General Mills is

6:43

sort of preaching at these different conferences

6:46

around the country. And then

6:48

on top of that, they're also directly paying

6:50

dieticians, some of whom are anti-dieticians

6:52

by their own right to promote

6:54

their products. And so you'll see

6:56

paid partnership, hashtag sponsored for General

6:58

Mills products like cereals or sugary

7:00

snacks on social media like TikTok

7:02

or Instagram. How is this different

7:04

than the ongoing relationship that food

7:06

companies have had with food

7:08

science and nutrition research? Because that's existed for

7:11

a long time, right? Yeah, we

7:13

mentioned the story too that General Mills has

7:15

also just directly funded the research to sort

7:17

of show that their cereals in particular are

7:20

nutritious. They're ready to eat cereals. This is

7:22

something that the food industry in general has

7:24

done for many, many, many years. We see

7:26

this as sort of like an evolution of

7:28

the strategy. A lot of the anti-diet messaging

7:30

is really effective, very popular, very compelling.

7:32

And so the food industry we see

7:35

as actually taking

7:37

this messaging to further support their

7:39

kind of bottom line and push

7:41

back against regulation that

7:43

is really a long time coming. Is that why

7:45

you see it happening now because that regulation is

7:48

coming, but also because there's this larger conversation around

7:50

what people call ultra-processed food, for example? I think

7:52

it's both, right? I mean, again, I would say

7:54

front of package labeling has been something that's been

7:57

an ongoing fight in the US for years and

7:59

years. years now, but now we have

8:01

the FDA saying they're really going to actually

8:03

do something and legislation

8:05

in Congress has been introduced to bolster that.

8:07

So it seems more and more likely that

8:09

that regulation will happen, but again, the food

8:12

industry is going to use its whole weight

8:14

to push back against it. This article got

8:16

a lot of attention and some pretty vigorous

8:18

reaction from a lot of dieticians, as you

8:20

could probably imagine. The phrase hatch a job

8:22

was used by a Canadian dietitian, Abby Langer,

8:25

who took to Instagram to say this. If

8:27

the Washington Post has no faith in the

8:30

ethics of registered dieticians, then who is the

8:32

public supposed to go to for nutrition information?

8:34

Natural path? Unregulated nutritionists

8:37

and nutritional therapists? No.

8:40

The majority of registered dieticians are helping

8:42

people live healthier, happier lives. We have

8:44

the most qualified profession in the world

8:46

to counsel individuals on what and how

8:48

they should eat. You analyzed

8:50

the social media posts of a group

8:52

of 68 dieticians on social media.

8:54

Is it possible to generalize about a profession based

8:57

on what you found? So

8:59

the 68 dieticians we looked at

9:01

are meant to represent the online

9:03

influencers that had the biggest followings, right? This is

9:05

not meant to represent by any means

9:07

the full profession. There I think is

9:09

a small percentage of dieticians that is

9:11

even on any of these platforms to

9:14

begin with. So we designed that universe

9:16

to represent the sort of growing online

9:18

presence of dieticians on social media, some

9:20

of whom have millions of followers. What

9:22

do you make of the fact that

9:24

you've been even accused of doing a

9:27

hatchet job, that you're targeting people who

9:29

are anti-diet when there's all sorts of

9:31

influencers who promote diet culture, calorie counting,

9:33

supplements, green juice, etc? I

9:35

mean, part of the reason we did this follow

9:38

story was registered dieticians, some of whom are quoted

9:40

in the story, reached out to us after our

9:42

first story to say, you need to be addressing

9:44

this anti-diet movement. There are dieticians sort

9:46

of in the field who maybe aren't influencers

9:49

online, who are working in dietetics,

9:51

doing nutrition research, doing metabolism research,

9:54

who were getting increasingly concerned

9:56

by sort of the lack of nuance and

9:58

some of the more extreme messages from. their

10:00

peers online, concerned about people

10:03

making really blanket statements about nutrition,

10:05

like chronic diseases don't have anything

10:07

to do with nutritional choices or

10:10

totally deny the connection between excess

10:12

body fat and disease at a

10:15

time when many diseases are at

10:17

record highs in the US right now. And so

10:19

I think some dieticians

10:21

are also concerned by what their peers are

10:23

doing online. What would you want, I mean

10:25

given to Abby Langer's point, you know, the

10:27

flood of information about this, what

10:29

would you want people to take from this

10:32

in terms of how to interpret what they're

10:34

seeing online? Yeah, I think the

10:36

best advice is actually when I spoke to one

10:38

of the leaders of ASDO, which owns

10:41

the Health at Every Size trademark,

10:43

she's a registered dietician herself and

10:45

she sort of was saying registered

10:47

dieticians or anyone shouldn't be making

10:49

any kind of blanket advice about

10:52

something as really personal as

10:54

health and nutrition. And so when

10:56

navigating social media, I think it's

10:58

really important one to be skeptical,

11:00

but if you're hearing something that's

11:02

very broad, very general, it's important

11:04

to get that personalized advice from individualized,

11:07

you know, healthcare provider as opposed to

11:09

just trusting inherently what you're seeing on

11:11

social media. Caitlin, thank you very much.

11:13

Thank you so much, Matt. Caitlin

11:16

Gilbert is a data reporter with

11:18

The Washington Post. Vinci Choi is

11:20

a private practice dietician and certified

11:22

intuitive eating counselor based in Calgary

11:25

as well as the founder of

11:27

the weight inclusive dieticians in Canada.

11:29

Vinci, good morning to you. Good

11:31

morning. Thanks so much for having me. What was your response

11:33

when you saw what The Washington Post

11:36

was reporting on here? I think, you

11:38

know, a lot of my colleagues

11:40

have written very well about this

11:42

and I think I kind of

11:44

agree with sort of the clip

11:46

that you played from Abby Langer that there

11:48

is a feeling that dieticians are being

11:50

targeted here and, you know, it's

11:53

interesting how there's this frame of,

11:55

you know, it's the food industry

11:58

co-opting anti-diet messaging, but how how

12:00

it sort of come out in the

12:02

report feels like dietitians being targeted, right?

12:04

Like in addition to two joint investigations

12:07

done by the Post and the examination

12:09

on the same data set of influencer

12:12

dietitians, there was also another article in 2022

12:14

on food companies sponsoring

12:17

the Fencey conference that Caitlin was

12:19

just mentioning. So yes, I can

12:21

see the argument that as health

12:23

providers, maybe dietitians should be held

12:25

to a higher standard, but why

12:27

are we only reporting on dietitians

12:29

when doctors or other health care

12:31

providers are also attending conferences sponsored

12:33

by pharmaceutical companies or other industry

12:35

people. If we talk about dietitians,

12:37

I mean, how concerned are you

12:39

that the food industry seems to be

12:41

looking for a way to capitalize on

12:44

an anti-diet movement, to use it to

12:46

promote their own products, to say that

12:48

these cereals are healthy for you, and

12:50

we're going to talk about how you shouldn't feel any

12:53

shame for what you're eating. And by the way, eat this.

12:56

I think it is concerning, but I

12:58

think there is nuance to it as

13:00

well. I think people have this image

13:03

of, you know, dietitians working at a

13:05

clinic, doling out meal plans, teaching Canada's

13:07

food guide, like that's not what we

13:09

do, right? Yes, there are dietitians working

13:11

in clinical settings, but there's also dietitians

13:14

working in public health, working for

13:16

sports teams, working in research and

13:18

academia and dietitians who do health

13:21

communication. So this is their income.

13:23

And I think this framing that, you

13:25

know, big food is co-opting this messaging

13:27

is a little bit insulting. Like I

13:30

do trust that my colleagues who do

13:32

this work are being selective about the

13:34

brands that they're choosing to work with

13:36

and also costing messages that

13:38

align with the evidence and their

13:40

values as dietitians. Can I

13:43

ask you more about that? I mean, as somebody

13:45

who's practicing in Alberta, what are the rules around

13:47

things like conflict of interest and paid endorsements so

13:49

that the people who are reading or receiving

13:52

the information know that it's

13:54

coming from you, not

13:57

from somebody who's paying you. And if they are paying you,

13:59

that you have to do. schools. What are those rules? So

14:02

kind of like you alluded

14:04

to in Canada, dieticians, and

14:06

I think a lot of other health professionals

14:08

as well are regulated provincially. So

14:10

being from Alberta, I'm regulated by

14:12

the College of Dieticians of Alberta,

14:14

and through them they have a

14:17

code of ethics with specific

14:19

sections on advertising and conflict of

14:21

interest. And then from there, like

14:23

in more recent years, I would

14:25

say maybe less than 10 years ago,

14:28

they also published some social media practice

14:30

guidelines that kind of build upon the

14:32

sections on conflict

14:34

of interest. And so if it's

14:36

helpful for me to even kind

14:38

of quote what they've written here

14:40

in their social media guidelines, they

14:42

talk about, you know, especially for

14:44

disclosures, like dieticians must also disclose

14:47

all affiliations, partnerships, sponsorships, employment, and

14:49

conflicts of interest open clearly and

14:51

inconspicuously and should catch viewers

14:53

slash readers attention. And they also link to

14:56

sort of some other guidelines. Do you think

14:58

people are doing that uniformly? I mean,

15:00

not just in Alberta, but broadly, if you take a look at the

15:03

field and what's being said on social media? I

15:06

think, unfortunately, it hasn't been consistent.

15:08

I mean, as you know, kind

15:11

of that first investigation from the

15:13

Washington Post sort of indicates this

15:15

is unfortunately not happening consistently. And

15:18

I think also, like the guidelines

15:20

could perhaps be more strict in terms

15:22

of, okay, like what does openly clearly

15:24

and inconspicuously mean? Does it mean that

15:26

it has to be that the person

15:28

is saying it in the video? Does

15:30

it mean that it's like a caption

15:32

in the video? I think there are

15:34

still some lack of clarity that perhaps

15:36

could be made more clear by the

15:38

regulators. I just wonder, and part of

15:40

this is about ethics, right? Whether it's,

15:43

it's ethical for somebody to take money

15:45

from a company that, for example, might

15:47

make sugary cereal and then say

15:50

on social media with the

15:52

hashtag that you shouldn't be ashamed

15:55

about eating whatever you want to eat. Is

15:58

that ethical? I mean, I think

16:00

there are like a couple parts to

16:02

this, right? Like one, like I think

16:05

there are going to be some people

16:07

who argue that dieticians or other health

16:09

professionals should not be working with industry

16:11

to begin with. And I think that

16:14

is a valid argument. And I know

16:16

there are dieticians who do make that

16:18

choice, you know, like even if they

16:20

are on social media to not do

16:22

any sponsored posts. And I think even

16:25

within the code of ethics and

16:27

the social media guidelines, what they

16:29

do talk about is like either

16:31

avoiding or disclosing. So perhaps with

16:33

enough disclosure, like that is still

16:35

falling within or that is still

16:37

addressing or mitigating that conflict of

16:39

interest. I also want to say

16:41

like, I think there's definitely a

16:43

bias here that's kind of coming

16:45

up around food and this idea

16:47

of good food and bad food and

16:49

like, or the idea that processed food

16:52

or ultra processed foods are bad. And

16:54

therefore like dieticians shouldn't be recommending them.

16:57

Are they not bad? I mean,

16:59

isn't there not a litany of

17:01

information studies what have you to

17:03

show that they're bad? I

17:06

don't think it's as straightforward

17:08

as saying like, we should

17:10

not eat ultra processed or

17:12

processed foods. Processed foods exist

17:14

because they do serve a purpose.

17:16

I think it would be very unrealistic

17:19

and elitist to say that we should

17:21

not eat ultra processed foods.

17:23

People eat ultra processed foods

17:25

or processed foods because of

17:27

time, because of access,

17:29

because of cooking skills or

17:31

lack thereof. There are lots of

17:34

reasons why people choose processed and

17:36

ultra processed foods. And by telling

17:38

people, no, you shouldn't eat them

17:41

that has the potential to not

17:43

be particularly helpful or worst case

17:45

scenario harmful and kind of like

17:48

increase that risk of disordered eating.

17:50

And so I think it's not as black

17:52

and white as it's being made out to

17:55

be. And I think that's why some of

17:57

these dieticians are saying the things that they're

17:59

saying. like these are things that I

18:02

would say as a dietitian that like

18:04

people choose processed foods for a lot

18:06

of different reasons and it's okay to

18:09

still include them because it's not realistic

18:11

to tell someone to not eat any

18:13

processed foods at all. And

18:15

so I think in a lot of cases,

18:18

these are things that dietitians are

18:20

already saying because it's

18:23

not very black and white. Like when

18:25

we're talking about nutrition, it's not just

18:27

what's happening at the cellular level. Like

18:29

maybe that is black and white, but

18:31

when we're talking about humans eating food,

18:33

we're talking about psychology, we're talking about

18:36

sociology, we're talking about access, economics. There's

18:38

lots of factors that are being at

18:40

play here and it's not as simple

18:42

as saying, don't eat this, this

18:44

is bad. If we're talking about sponsored

18:46

content, what's your own attitude toward that?

18:50

If you don't mind me asking, do you

18:52

provide sponsored content? Do you take sponsored content?

18:54

Do you promote sponsored content? I

18:56

don't. And I mean, it's partly

18:58

because I don't have the millions

19:00

of followers. Like I only have like 6,000

19:03

or something on Instagram. So I

19:05

don't. It's more than me, but continue. And also I'm

19:07

like. And I

19:09

just like don't really have the time. I think if it

19:12

was a brand that I supported

19:14

or used already and

19:17

it was like a messaging that I

19:19

aligned with, yes, I would. And of

19:21

course, like I would disclose that to

19:23

my followers. What would you say, this

19:25

is the question that I ask Caitlin

19:28

as well. What would you say to people who

19:30

are just inundated with all of these bits of

19:32

information, often conflicting on social media about food and

19:34

diet and they're trying to figure out what the

19:36

right thing to do is and what they should

19:38

eat and what they shouldn't eat and how much,

19:40

what would you say to them about how

19:42

they should navigate through this given what

19:44

we've been talking about? I know like

19:47

this is so hard and I think

19:49

dieticians on social media do it to

19:51

make nutrition information more accessible because it's

19:54

not easy to get to see a

19:56

dietician, right? If you're seeing a private

19:58

practice dietician, there's a- cost involved and

20:00

even if there isn't a cost involved,

20:03

most are working daytime hours.

20:05

So it's hard and unfortunately,

20:07

it's hard to capture nuance

20:09

about nutrition in a 60 second

20:13

or even less like TikTok reel or even

20:15

like a longer YouTube video. So

20:17

I think recognizing that it is

20:19

hard and that if you do

20:21

have a way to access a

20:23

dietitian to help you kind of

20:25

get that individualized support like similar

20:27

to what Caitlin said, I would

20:29

take advantage of it. And I

20:31

think remembering that it is important

20:34

to be critical and also be curious about

20:36

things that maybe push up against some of

20:38

our own beliefs and biases. Vinci, I'm really

20:40

glad to talk to you. It's an important

20:43

part of this conversation. Thank you for being

20:45

here. Thanks so much for having me. Vinci

20:47

Choi is a private practice dietitian, certified intuitive

20:50

eating counselor based in Calgary, as well as

20:52

the founder of weight inclusive dietitians in Canada.

20:56

Hello, I'm Jess Milton. For

20:58

15 years, I produced the vinyl cafe with

21:01

the late great Stuart McLean. Every

21:03

week, more than 2 million people tuned in to hear

21:05

funny, fictional, feel good stories about Dave and

21:07

his family. We're excited to welcome

21:09

you back to the warm and welcoming world

21:12

of the vinyl cafe with our new podcast

21:14

backstage at the vinyl cafe. Each

21:16

week, we'll share two hilarious stories by Stuart.

21:18

And for the first time ever, I'll tell

21:20

you what it was like behind the scenes.

21:23

Subscribe for free wherever you get your

21:25

podcasts. Alison Thompson

21:27

is a bioethicist and associate professor at the

21:29

University of Toronto. She's been listening into our

21:31

conversation. Alison, good morning to you. Morning to

21:34

you. What do you make of what the

21:36

post uncovered about these ties such as they

21:38

are between the food industry and dietitians who

21:40

also happen to be social media influencers? Well,

21:43

you know, I think it's a bit of deja vu really.

21:45

And Vinci's right, this is shining

21:47

a spotlight on one particular healthcare

21:50

profession where this is happening, but

21:52

this is something that you know,

21:54

we've been looking at how to

21:57

prevent the undue influence from commercial

21:59

actors on. physicians for years and

22:01

we know that very similar marketing

22:03

strategies are being used between big

22:05

food and big pharma. It's interesting

22:07

to look at it in this

22:10

particular context but the broader issue

22:12

is really about what are we

22:14

doing in Canada to really look

22:16

at this issue because commercial actors

22:19

do shape very much our ability

22:21

to make choices and our health

22:23

and the equity of the population

22:26

health overall. Are you surprised to hear about

22:28

these conferences that Caitlin Gilbert was talking about, the

22:30

way that she writes about them, nutrition conferences that

22:32

happen to have major sponsors from

22:34

the food industry and people can

22:37

line up and go down a slide into a

22:39

bowl of Cheetos and that kind of thing like

22:41

that. Are you surprised to hear about, that seems

22:43

a very obvious way to try

22:45

to shape behavior and shape influence. Yeah,

22:48

you know those large healthcare conferences

22:50

are very often sponsored by industry

22:52

partners so I'm not surprised at

22:54

all. That's sort of the norm

22:56

I think for those large congresses

22:59

where you have a large group

23:01

of healthcare professionals, they're very expensive.

23:03

The societies or colleges themselves can't

23:05

really support the cost of that.

23:07

They need those industry sponsors to

23:09

have those but we're not

23:11

doing a great job at looking at

23:14

the issues around undue influence that happens

23:16

at those types of meetings but there's

23:19

many other ways in which they

23:21

are influencing endorsements

23:23

from dieticians or prescribing behavior on

23:26

the part of physicians. Vinci talked

23:28

about what the regulations may

23:30

be in Alberta. As you understand it

23:32

across this country, I mean how consistent

23:34

are the rules about how dieticians should

23:36

handle paid content and sponsorships in

23:38

terms of what they're talking about online? So

23:41

the regulatory colleges for dieticians across

23:44

the country all speak to this

23:46

issue around conflict of interest and

23:48

they're very clear that a dietician

23:51

should not be personally profiting

23:53

or taking money from

23:56

a company that if the public were to

23:58

know or a reasonable person could look

24:00

at it that you could, you know, suspect

24:02

that there is some undue influence or introducing

24:04

some kind of bias there. So I think

24:07

it's very clear in all the codes of

24:09

ethics and practice standards across the country that

24:11

this is not okay. And, you know, some

24:14

of them are more specific. For

24:16

example, British Columbia, they have very

24:19

explicit guidelines for marketing and things

24:21

like that. But endorsements are definitely

24:23

flagged as a very problematic area

24:26

and they will distinguish between you're

24:28

welcome to recommend a product, but

24:30

if you take money for it, then

24:33

it's an endorsement and then that's a very

24:35

clear conflict of interest. Is it just about

24:37

money or is it also what a Caitlin

24:39

talk about that, you know, the personalized box

24:41

of cereal with your face on it or

24:43

something like that, that there could be other

24:45

ways to shape behavior?

24:48

Absolutely. So in the, you know,

24:50

physician space, you know, we're looking

24:52

at these kinds of

24:54

issues with big pharma, it's called transfer

24:56

of value. So that could be a

24:58

pen, it could be a

25:01

meal, it could be continuing education,

25:03

it could be an actual fee

25:05

for a talk that you give.

25:08

In this case, you know, we

25:10

don't really see physicians shilling for

25:12

drug companies in this kind

25:14

of way anymore, but certainly it used to

25:17

happen. But I think we're just seeing a

25:19

healthcare profession that is just

25:21

starting to deal with this and, you know, partly

25:23

because of social media and, you know, it could

25:25

speak to an issue about the fact that dieticians

25:27

are not paid well enough. Well, Vian Vinci talked

25:29

about it as well. This is part of in

25:31

some ways how people make a living. Yeah.

25:34

And so I think that's a bigger issue.

25:36

That's about, you know, inequities across in pay

25:38

and for healthcare professions that are dominated by

25:41

women, we know that they're paid worse. So

25:43

there could be a bigger issue there, but

25:45

that does not necessarily mean that this is

25:47

okay. How successful do you think the food

25:49

industry has been at shaping our ideas of

25:52

what we should and shouldn't be eating? You

25:55

know, I do think that

25:57

the relationship between commercial actors

25:59

and around big food

26:01

conglomerates, big sugar, whatever it

26:03

is. They are having a

26:05

very large impact on research,

26:07

on healthcare provider behavior, and

26:10

ultimately they are shaping patient choices, which

26:12

we know down the road will impact population

26:14

health overall. So I don't think you can

26:16

underestimate the influence that these commercial actors are

26:18

having on. So what should we do

26:20

about that then? I mean, these are big

26:23

companies. They have a lot of money and

26:25

they have clearly a lot of influence

26:27

as well. I mean, and it's not just

26:29

lobbying lawmakers and trying to sponsor their

26:31

own studies. It goes beyond that.

26:33

So what are we supposed to do about that to understand

26:37

how people can trust what they're

26:39

reading and get the best advice

26:41

possible? I mean, there's not one

26:43

answer to that question. There's many things that

26:45

can be done, both on the regulatory side,

26:48

on demanding more transparency, on

26:50

the regulatory colleges actually managing

26:52

these conflicts more actively rather

26:55

than waiting until someone lodges

26:57

a complaint with the college

26:59

to react to it. But

27:01

also, the bigger issue particularly

27:03

around the funding of

27:05

research is in Canada, we

27:07

are seeing a serious

27:09

contractor of research funding

27:11

from the federal government. So

27:13

we are asking universities to turn to

27:16

industry partners more and more to support

27:18

research programs. And we know very clearly

27:20

that that does introduce bias, even when

27:22

there are very clear guidelines about industry

27:25

may provide the money, but they don't

27:27

have anything to do with the design

27:29

of the study. It doesn't

27:31

actually matter. We know that industry

27:33

funded research tends to have more

27:35

positive outcomes. Do you see this

27:37

just finally as a continuum

27:40

of the conversations that we have,

27:42

it seems like on a regular basis, around misinformation

27:45

on the internet? We

27:47

started in talking about social media and

27:49

influencers on social media and hashtags being

27:51

applied. Is this part of that misinformation

27:53

conversation? I think so. I

27:56

think that it's also about the integrity of

27:58

the people on the internet. social media

28:00

and the fact that it's very hard

28:02

to judge that even if they do

28:04

disclose a paid endorsement. I think you're

28:06

putting the onus on the consumer or

28:08

the patient to do the due diligence

28:10

there and it's a buyer beware situation

28:12

whether you're going to consume this information

28:15

or not. I think we can be

28:17

doing a lot better in terms of

28:19

forcing health care providers and industry to

28:21

take more responsibility for the messages that

28:23

they're putting out there. Alison, good to

28:25

talk to you about this. Thank you

28:27

very much. Thank you. Alison Thompson is

28:29

a bioethicist at the University of Toronto. For

28:31

more CBC podcasts go to

28:33

cbc.ca