It’s complicated…is that bad?

1

January 16, 2013 by kevintmiller

If this is to be my reflection on the trip, I will give my honest reflection.  The most important thing I took away from a trip to DC to hear about nutrition policy is a thoroughly reinforced desire to be a clinical dietitian and stay as far away from policy as I can.  I know, I know…policy will affect everything that I do in a hospital or other clinical practice.  I know, some of our panelists said they would like to hear from those of us in the field, the “subject matter experts” to be able to help inform policy.  However, one thing I can’t get out of my mind from the first day of seminars was when one of our panelists said explicitly that she had staff of Congressmen calling her and asking her to tell them specifically how he (the Congressman) should vote on a bill.  A recurring theme of our panel discussions was that regardless of Schoolhouse Rock (yes, it was mentioned at least twice) portrays the passage of legislation, in the real world things are more complicated.Image

 It is my belief that, when coming to the table to discuss nutrition policies for our nation, if maximizing health for our nation’s people is not the top priority of everyone involved (and I don’t believe that it is, here in the real world) then we’re doing it wrong.  Ultimately, if the complications of passing bills involve a Congressperson asking an individual who isn’t even a constituent of said Congressperson to tell him/her how to vote, I think I’ll just keep my head down and work on using nutrition to keep people alive.  I appreciated hearing a bit about organizations like Share Our Strength and Feeding America, who are fighting a good fight in a very tough environment, but it’s not a job I would ever want.

At a social gathering this past weekend, I talked a bit about the DC trip I’d just been on and talked about being a dietitian.  A new acquaintance lamented that he was confused and in disbelief over what he should eat because “they change it all the time.”  This brings me to panel discussions from the second day of the seminars, during which we talked about governmental role in nutrition education and the status of nutrition labeling.  I enjoyed hearing the White House representative from the Taskforce on Childhood Obesity talk about her efforts with Let’s Move and despite the frustration that some of my classmates feel over the fact that the initiative is gaining ground because of the endorsement of a celebrity, my feeling on it is that at least this celebrity (our First Lady) seems to be trying to push people to be more healthy, for what seem to be mostly altruistic reasons.  I wish that good initiatives didn’t have to have that sort of backing, but my feeling about the staff member who came to talk with us is that she really does want to be a part of something for the common good, and I like that.  So here I can come back to the friend versus foe idea.  I suppose that when I see that people who have great influence over policy do not (cannot, because of their jobs?) have as an ultimate goal the common good/health of everyone, that’s when I bristle and start to feel some opposition.  It’s not so much a problem that people represent individual interests when all individual interests are represented equally at a table for discussion, but once again, this ain’t no Schoolhouse Rock.  I became keenly aware of this when we were talked to by a representative from the Grocery Manufacturers Association.  At one point, this person said something to a room of budding registered dietitians that carried the implication that “we are the big boys making food the way we make it, so you’ll just have to take that into account when you counsel patients.”  That’s the way I heard it, anyway.  So I started thinking about these DGAs we have.  I don’t like that our DGAs come out of the USDA because I don’t think that a single agency should both work with food production and work with attempting to suggest what people should eat.  It isn’t that the panelist we hear from the USDA didn’t seem to be competent professional doing a good job.  No matter the good intentions of USDA folks involved, they’re working from the get-go with a conflict of interest.  Never fear that the interests of those producing our food will be heard and will be part of the process – and they should be.  If we can’t feed everyone, it doesn’t matter if we have great recommendations on how to keep people healthy.  That being said, though, I think that when we (the government) are suggesting to people how they might eat to be healthiest, it should be from a medical perspective, taking into account only what best scientific research says about what is optimal for the human body.  I know that this might create guidelines that are difficult for many, if not most, Americans to follow.  However, that’s someone else’s problem.  It’d be nice if educated Americans who want healthy food could pressure food manufacturers into making better foods, wouldn’t it?  On an individual basis, I can help my patients or clients reconcile what is best with what exists.  That is my job.  That’s nutrition education.  It isn’t, in my opinion, the job of food industry to educate people on what they should eat (though if the government mandates labeling initiatives they should provide that information on their foods or menu boards), but if those of us who do are successful then I’d like it if industry had to step up and supply the foods, to the best of their ability, that my clients demand for a healthy diet.  The implication I heard from the GMA was a recognition that that just isn’t going to happen anytime soon.  Food producers simply have too much power and people trying eat healthy have too little. Image

I just think that recommendations and production are tied too closely together so that there really isn’t equal say from what are sometimes competing interests.  If they were, maybe then the general public wouldn’t feel like we just keep changing our minds about what people should eat.  After hearing talks from the third day, I think that a system like that would be much easier to set up in some international settings rather than here in the United States.

Overall, though there were other themes throughout the three days of talks, the two that stuck with me the most were the themes of friend versus foe and the theme that things are more complicated than they appear.  These aren’t surprising themes to me, but they are two things that must be strongly considered in policy discussions.  Everyone is coming to the table with different ideas and interests.  That doesn’t necessarily make them bad people.  In my opinion, those working in policy should have, as a top priority, making sure that Americans are as healthy as we can be.  I do think everyone comes to the table with that as a goal, but it’s not the top priority for everyone and that’s where the friend versus foe idea actually has some merit.  When everyone is working toward a common goal, the entire idea of any of those people being your foe is moot.  Unfortunately, because everyone isn’t working with a single common goal in mind and because we have competing interests, that’s where the second theme of complication comes in.  I don’t have any answers for any of this and it’s all just my opinion and my reflections on this experience.  If I had any answers, maybe I wouldn’t want to hide in a hospital.  Image

But I do.  More power to those who want to work in policy and I fervently hope that any who read this and who do go into policy go forward with a single goal of making the best decisions for the common good.

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One thought on “It’s complicated…is that bad?

  1. lschoenfeld says:

    Nice job, Kevin. I get the sentiment of wanting to hide in the clinical world and never get involved in policy. Though this trip pushed me in the other direction – as much as I want to stay as far away from government as I can, I realized that if people like me don’t speak up, then the status quo will never be challenged. It might be a challenge, but I think it’s worth sticking my neck out to do the right thing. Hope you’ll at least openly support those who are trying to do things differently!

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