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Health quackery: Our role as professionals

1994; Elsevier BV; Volume: 94; Issue: 6 Linguagem: Inglês

10.1016/0002-8223(94)90154-6

1878-3570

Sarah H. Short,

Science, Research, and Medicine

What is our role, as health professionals, in the areas of health quackery, education, and the media? If we are to carry the burden of educating the public about health quackery, we need to be knowledgeable about some of its facets. “Nutrition misinformation, misbeliefs, fraud and quackery prevent the public from attaining optimal nutritional health” (1.J Am Diet Assoc. 1988; 88: 1589-1591Google Scholar, p 1589). A quack is defined as “a person who pretends to be able to cure a disease or health problem” (2.NY State J Med. 1993; 93: 153Google Scholar). Jarvis, president of the National Council Against Health Fraud, states that: “Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist” (3.Jarvis WT Quackery: a national scandal.Clin Chem. 1992; 38: 1574-1586Google Scholar, p 1574). A physician writing 107 years ago may have had the best idea about quacks: “If these people could be induced to take all their remedies at one sitting, the country would be less populous, but it would be better off” (4.JAMA 100 Years Ago. Newspapers remedies and the public. 2nd ed. JAMA. 256. 1986: 684Google Scholar, p 684). The audience at the 1985 National Health Fraud Conference was reminded that to have quacks, you have to have quackees (5.Blechman WJ Who are the health fraud victims?.in: Presented at the National Health Fraud Conference. September 11, 1985Google Scholar). Quackees are vulnerable because health professionals do not answer questions effectively or ignore patients' inquiries about fraudulent products. The public wants quick solutions to health and fitness problems. People become susceptible to quacks as they try to sort through all the conflicting information they receive about products claiming to have health benefits. One day the newspaper, radio, and television report that product X will reduce cholesterol, the next week they report that studies cast doubt on product X's benefits. Which story should the public believe? A confused public wants “sure” answers so they turn to quacks, who are always sure of what they are saying. However, what they are usually saying is “buy my product.” The victims of quackery are of all ages and income levels and the costs are high. “Americans spend an estimated $30 billion annually on worthless and often harmful products and treatments” (6.Lange RH Wolves in sheep's clothing.NY State J Med. 1993; 93: 85-86Google Scholar). Besides the many harmful side effects of spurious products, people may discontinue proven treatments with disastrous consequences. Those most vulnerable to fraud are people with diseases for which there are no known cures (7.Henney JE Combatting medical fraud.NY State J Med. 1993; 93: 86-87Google Scholar) and the elderly (8.Roe D Health supplements for the elderly. Who can say no?.NY State J Med. 1993; 93: 109-111Google Scholar). Instant weight loss products and fraudulent nutrition schemes are also commonly offered by quacks. Why all this quackery? At least four problems promote the growth of quackery. First, just about anything can be sold so long as it is called a dietary supplement. According to a Food and Drug Administration (FDA) commissioner: “I can tell you, and it is no secret, that in terms of safety of dietary supplements, FDA is not doing very much today. It is really ‘buyer beware!’ which Dr Kessler and many of us have said.” (9.Dykstra G FDA and dietary supplement regulation.in: Presented by the Deputy Associate Commissioner for Regulatory Affairs by video link to the National Nutritional Food Association. July 17, 1992Google Scholar). Dietary Supplement Health and Education Act bills (S 784 and HR 1709) have been proposed in both houses of Congress; S 784 is due to come out of committee for Senate action, and there has been no recent action on HR 1709. If passed, the new standards for health claims on supplements would be less strict than those required by the Nutrition Labeling and Education Act of 1990. A significant problem is that the burden of proof of safety would then be on the overburdened FDA, not on the manufacturer (10.Probert K Chapman N Public policy column.J Nutr Educ. 1993; 25: 165-166Google Scholar). In their giveaway publications, health food stores in shopping malls exhort their customers not to let the FDA take their supplements away. The sellers say they want the bill passed so that people can have freedom of choice; however, this means freedom to buy products that may be untested, unclean, and unsafe. Consumer protection in the area of supplements will be decreased if these bills are passed. One congressperson's office (Rep James Walsh, personal communication) indicated that letters were running 100 to 1 in favor of passage. Could this be because health food stores in shopping malls made it easy for customers to write their congressperson by providing paper, pens, and addresses of local congresspersons in the store? Can the public ever hope to have better protection in the area of dietary supplements? A multibillion dollar business carries a very large influence in Congress. Until federal, state, and local regulatory agencies have more power to restrict spurious claims and the supplements, the number of supplements will multiply to the detriment of the public. The New York City Department of Consumer Affairs issues Notices of Violation of the Consumer Protection Law for deceptive advertising against companies making unsubstantiated product claims, which is a step in the right direction (11.New York City Department of Consumer Affairs Magic Muscle Pills! Health and Fitness Quackery in Nutrition Supplements.May 1992Google Scholar). Second, because the First Amendment protects the right of free speech, nutrition books published for the public can be inaccurate or false. Many of the nutrition books on the market should be labeled fiction. Third, anyone who eats can call himself or herself a nutritionist. Is the public able to evaluate the accuracy of nutrition credentials? Unfortunately, thousands of “degrees” have been dispensed by nonaccredited schools. “Armed with dubious credentials, nutrition advisors on the fringe misrepresent themselves as being legitimate nutritionists” (12.Milner I Diploma mills grind out self-styled nutritionist dispensing bad advice.Environmental Nutr. 1993; 15: 1-3Google Scholar, p 6). Milner, chairman of the Task Force on Diploma Mills, National Council Against Health Fraud, looked at nutritionists listed in the yellow pages of more than 50 metropolitan areas in 27 states. He found that the public would have an almost 50% chance of finding someone with spurious credentials (13.Milner I. The color of quackery. Nutr Forum. In Press.Google Scholar). A fourth problem is that research scientists go public with their conclusions before their study has been duplicated. One research study or one epidemiologic survey does not prove a scientific theory. Science is built on an accumulation of scientific evidence assembled with well-planned studies. Conclusions are reached over time—perhaps over years. For instance, despite the fact that the topic of the relationship of diet and heart disease has been studied for many decades, questions remain. The public does not know what to believe. Most news features about the newest nutrition discovery are not really news, but are published or broadcast because nutrition is a hot topic—it sells. Schmitz, in a thought-stimulating article about food and nutrition news, quotes a newspaper editor who said “anybody who believes everything they read is nuts” (14.Schmitz A Food news blues.Health. 1991; (Nov): 40-47Google Scholar). How much science does the public understand? Not much, according to an article in the American Scientist(15.Hively W How much science does the public understand?.Am Scientist. 1988; 76: 439-444Google Scholar): “The middle-aged adults of the year 2010 are already in high school. Unless they are locked up until they learn more science, about 95% will be scientifically illiterate” (p 444). The public does not comprehend that a study done on nine people or 10 rats proves little. They believe the headlines. In addition, evaluating nutrition research is difficult. Quality nutrition research studies should have a significant number of human subjects (at least 50), appropriate control groups, controlled nutrient intake, adequate consumption data for periods before and after the experiment, a level of food consumption that is reasonable, and significant statistical results (16.Ink SL Evaluating nutrition research.in: Presented at the Food Health Claims Symposium, sponsored by Tufts University and the Food and Drug Administration, Boston, Mass.March 29, 1990Google Scholar). Few survey studies meet these specifications. Because athletics is big business in the United States, all of the nutrition quackery problems are intensified when it comes to sports nutrition information and products. Misinformation spreads through electronic and print media to the players, their coaches, the trainers, and the public (17.Short SH Marquart LF Sports nutrition fraud.NY State J Med. 1993; 93: 112-115Google Scholar). Today more than ever, athletes are searching for the competitive edge. The time difference between winning or losing is very small. In the 1992 Olympics men's 100-meter track event, there was a difference of only 0.08 of a second between winning a gold medal and placing out of medal contention (18.2nd ed. The 1993 Information Please Sports Almanac. Houghton Miffin Co, Boston, Mass1993: 572Google Scholar). Because proper training, coaching, and diet cannot guarantee success, athletes often resort to nutritional supplements as ergogenic (performance enhancing) support to provide an advantage. A recent survey of nutritional supplements in health and bodybuilding magazines found “89 brands, 311 products and 235 unique ingredients, the most frequent of which were unspecified amino acids … ” (19.Philen RM Ortiz DI Auerbach SB Survey of advertising for nutritional supplements in health and bodybuilding magazines.JAMA. 1991; 268: 1008-1011Google Scholar, p 1008). Has the scientific research demonstrated the claims made for these products or their ingredients? No, but the athletes, as well as the public, think that anecdotes and advertisements are proof of efficacy. Deceptive tactics used in selling these products have been outlined (20.Lightsey DM Attaway JR Deceptive tactics used in marketing purported ergogenic aids.Natl Strength Conditioning Assoc J. 1992; 14: 26-31Google Scholar). Tactics include taking published research out of context, claiming products are university tested when no research has been done, using unauthorized endorsements by professional organizations, using false statements that research is currently being performed, using testimonials, referencing research inappropriately, patenting products (which is not proof of effectiveness), and engaging in mass media publicity. Most athletes do not understand the risks inherent in using new untested products, nor are they concerned about future health problems related to these products. Younger athletes may be the most frequent users of nutritional supplements and may encounter larger risks. A review of athletes' use of vitamin-mineral supplementation found a range between 6% and 100%, and most studies reported that more than half of the athletes consumed supplements (21.Marquart LF Sobal J Vitamin/mineral supplement use among athletes.J Am Diet Assoc. 1992; 92 (A-56) (Abstract)Google Scholar). Several factors may contribute to athletes' increased use of nutritional supplements. Coaches, athletes, and the public have inadequate knowledge of sports nutrition (22.Short SH Surveys of dietary intake and nutrition knowledge of athletes and their coaches.in: Wolinsky I Hickson JF Nutrition in Exercise and Sport. 2nd ed. CRC Press, Boca Raton, Fla1994: 367-416Google Scholar). Coaches believe they should provide nutrition information to the athletes, although few have any formal nutrition training. Some coaches actually suggest that athletes take supplements of vitamins or amino acids. Health professionals must bear some blame in all of this. In many cases, advice (including supplementation) for athletes is presented in books, articles, and in person as if all athletes have the same needs. Nutrition advice must be individualized. For instance, when providing nutrition information, it is necessary to know whether the athlete is involved in an endurance or short-term event, body composition (if possible), age, time spent practicing and training, and whether the athlete is training for a competition lasting 1 day or one held on successive days. Nutrition advice that is provided for athletes in general makes little sense (23.Short SH Dietary surveys and nutrition knowledge.in: Hickson JF Wolinsky I Nutrition in Exercise and Sport. CRC Press, Boca Raton, Fla1989: 309-344Google Scholar). Bodybuilding magazines are a good example of how athletes are bombarded with information about questionable products. Several so-called bodybuilding magazines are published only as vehicles to publicize nutritional products. The New York City Department of Consumer Affairs indicated that 56% of full-page advertisements for nutritional supplements in four popular bodybuilding magazines were for worthless and possibly harmful products (11.New York City Department of Consumer Affairs Magic Muscle Pills! Health and Fitness Quackery in Nutrition Supplements.May 1992Google Scholar). The amount of money spent on these supplements can be substantial. College athletes may spend as much as $400 per month on supplements. This is money that would be better spent on food. We must work with athletes of all ages to discourage them from buying quack products. Athletes are eager for nutrition advice and are motivated to change eating habits because they believe this would be an advantage in competition (24.Short SH Short WR Four-year study of university athletes' dietary intake.J Am Diet Assoc. 1983; 82: 632-645Google Scholar). Products used by athletes and fitness enthusiasts include amino acids, alternatives to growth hormones or anabolic steroids, trace minerals, herbs, glandulars, vitamin-mineral supplements, and “stack-packs,” which consist of a variety of these products sold in one plastic package. How can dietetics professionals research what is in these products? Several helpful books describe ergogenic aids (25.Tyler VE The Honest Herbal, a Sensible Guide to the Use of Herbs and Related Remedies.in: 3rd ed. Pharmaceutical Products Press, New York, NY1993Google Scholar, 26.Contursi J Kleiner S Mielcarek J Nutrient and quasi-nutrient supplement consumption.in: Benardot D Sports Nutrition. A Guide for The Professional Working With Active People. American Dietetic Association, Chicago, Ill1993: 238-250Google Scholar, 27.Williams MH Ergogenic Aids in Sports. Human Kinetics Publishers, Champaign, Ill1983Google Scholar, 28.Herbert V Barrett S Vitamins & “Health” Foods: The Great American Hustle. George F. Stickley Co, Philadelphia, Pa1982Google Scholar, 29.Barrett S Health Schemes, Scams, and Frauds. Consumers Union, Mt Vernon, NY1990Google Scholar, 30.Zwicky JF Hafner AW Barrett S Jarvis WT Reader's Guide to Alternative Health Methods. American Medical Association, Milwaukee, Wis1993Google Scholar, 31.Butler KA Consume's Guide to “Alternative Medicine”. Prometheus Books, Philadelphia, Pa1992Google Scholar). Dietetics professionals also need to ask athletes what they are taking, buy a muscle magazine, or go to the local health food store or gym and investigate what is being sold. Keep in mind that the research can be arduous because many products contain substances that are extremely difficult to trace, such as herbs, glandulars, or little-known chemicals. The FDA does not require herbal products, which are often marketed as over-the-counter medications, to adhere to the same standards as conventional over-the-counter products. Herbal products are sold as foods. Such products cannot make drug claims on the labels, but books, pamphlets, and magazines making widespread healing claims for these products are usually featured somewhere in the store (32.Jarvis WT Quackery: A national scandal.Clin Chem. 1992; 38: 1574-1586Google Scholar). Herbs with medicinal uses should be regulated as new drugs. I have accumulated a collection of questionable products over the years. One product—yohimbe—is worth mentioning, not because it is the worst or most dangerous, but because it is an example of the difficulty health professionals face in finding out about these products. Yohimbe is sold as a single product and as part of many muscle-building products. The major alkaloid in yohimbe is yohimbine, which is a prescription drug. Ads for yohimbine in medical journals feature the symbol for the male gender and the statement: “may have activity as an aphrodisiac.” In health food stores, yohimbe is sold along with other products for men, and the label states “you are virtually guaranteed strength, stamina and energy.” According to FDA, documented health hazards include hypotension, weakness, and nervous stimulation followed by paralysis, fatigue, stomach disorders, renal failure, seizures, and death (33.Unsubstantiated Claims and Documented Health Hazards in the Dietary Supplement Marketplace. Dept of Health and Human Services, Public Health Service, Food and Drug Administration, Washington, DC1993: 101Google Scholar). Yohimbine is a monoamine oxidase inhibitor; thus, adverse effects can be expected when it is used with liver, cheese, red wine, nasal decongestants, and diet aids. Because the typical health store version of yohimbe is an “extract,” it could contain a variety of ingredients. Yohimbe is also an ingredient in a product very popular with athletes and bodybuilders. This product was on a recent list of products against which FDA is taking regulatory actions (33.Unsubstantiated Claims and Documented Health Hazards in the Dietary Supplement Marketplace. Dept of Health and Human Services, Public Health Service, Food and Drug Administration, Washington, DC1993: 101Google Scholar, p 101). Because people of all ages—athletes and the general public—want to believe in quick results and magic, we need a herculean educational program and a law with some teeth so that so-called magic products do not look so attractive. The American public lacks a basic knowledge of foods and nutrition. Thus, consumers are confused by nutrition issues. Consumer service directors of food manufacturing companies are amazed at how little most consumers know about food preparation. One consumer director provides an example of a man who called about a lumpy chocolate mousse. When asked how the egg had been beaten, the man replied that he had used hard-boiled eggs in the mousse. Consumer managers of manufacturing companies have had to change recipes, simplify directions, and add pictures to make food preparation easier (34.Sloan AE Cooking? They don't have a clue.Food Technol. 1993; 47: 42-44Google Scholar). Dietetics professionals may need to do the same with nutrition advice. Expanding nutrition education in the schools is a Healthy People 2000 objective (35.DHHS publication No (PHS) 91-50212. 1990; (Washington, DC)Google Scholar). Objectives call for at least 75% of US schools to offer nutrition education from preschool through 12th grade. All states and school districts should require nutrition education. This, of course, means that teachers must be knowledgeable about nutrition. Nutrition coursework should be a part of teacher preparation (36.Nutr Today. 1990; 25: 29-39Google Scholar). Nutrition needs to be part of the basic educational curriculum from kindergarten through medical school. The study of nutrition should be part of reading, mathematics, history, chemistry, and as many other subjects as possible. An enlightened public might then stop spending money on worthless dietary products, books, and supplements. Chevalier Jackson once said: “In teaching … , the primary requisite is to keep [learners] awake.” After you have their attention, you need to discover what they already know and what they want to know (37.McNutt K Improving the cost effectiveness of nutrition education.Nutr Today. 1992; 27: 38-40Google Scholar). Consequently, dietetics professionals must recognize the fact that when it comes to eating, people may be more interested in topics other than nutrition. Consider that a person's primary concern may be cost, with taste a close second, or that another person's main concern may be getting home safely from the grocery store. Further, some people may be uninterested in nutrition information because they do not believe in science at all. In that event, my advice is to avoid debating with someone who believes that the earth is flat. I am sure you are familiar with the quote “I'm mad as hell…” from the movie Network. The rest of the quote is appropriate to the topic of quackery. In the film, the national television news anchor, who was fired in his last broadcast, says to his audience:I want you to get mad. Things are bad. The air is unfit to breathe. Food is unfit to eat. Get up now out of your chairs. Open the window and say, “I'm mad as hell and I'm not going to take this anymore.” Less than 3% of you people read books. Less than 15% of you read newspapers. The only truth you know is what you get over this tube. Right now there is a whole entire generation that never knew anything that didn't come out of this tube. TV is not the truth—it is in the boredom-killing business. Unfortunately, this whole quote may be just as true today as it was in 1976. People do not read. They sit in front of television screens believing anything that is heard or seen. From 1960 to 1992, the average daily television viewing per household went from 5 to 7:04 hours while average SAT scores declined from 975 to 899. Most of the general public do not read scientific journals. They believe the radio and television commercials and the infomercials. They believe the anecdotes and star athletes' product endorsements (38Bennett WJ Index of leading cultural indicators.Time. March 29, 1993; : 18Google Scholar). Things are, indeed, bad. News media of all types need headlines. If you tell people to buy “easyslimstuff” enough different ways, they are going to believe and buy this product. Sellers put advertisements in the newspapers, place misinformation into the supermarket magazines, or find someone famous (or not so famous) to say that he or she lost 60 lb overnight using this product. With enough exposure, or enough money to buy time, the misinformation and quack product promotions will soon be on television and radio. Who is going to doubt? People have seen it in print, heard it on radio, and seen it on television day and night. Many will go out and try it “just in case.” A former women's magazine writer makes one wonder about the validity of health articles in popular publications (39.Larkin M Confessions of a former women's magazine writer.Nutr Forum. 1993; 10: 17-20Google Scholar). She states that women's magazines are controlled by advertisers. The magazines need articles with attention-capturing titles and a voice of authority (an expert). Quotes by the experts are sometimes written without the expert's input. The magazine writer declared that these magazines make up facts and statistics, feature little quizzes, and use a chatty tone. The photographers may dictate what will be in the story depending on what looks good in the pictures (39.Larkin M Confessions of a former women's magazine writer.Nutr Forum. 1993; 10: 17-20Google Scholar). Obviously, not all magazines are guilty of these accusations, but these trends indicate that scientific reliability of their nutrition articles cannot be trusted. Should dietitians be interviewed on television and radio programs or in the print media? Yes, but we need some training in communication and we need to do our homework. Keep in mind the following tips.•Make your point quickly—in the first 10 seconds if possible; a guest on a national television program is allowed only 2 to 7 minutes of airtime.•Make a positive stand—no maybes or ifs. The issues may not allow us to do this, but we should always try to present data in as clear a manner as possible.•Do not debate diet-book authors or pill promoters. Why should you be part of their sales campaign by mentioning them?•Take time to read the current scientific literature and general publications.•Learn how to speak, smile, wear make-up, and dress for the media. Will you receive accolades for taking your time to bring accurate nutrition information to the public? Probably not. No one will thank you and, in fact, you may receive nasty letters from around the world. After I made a television appearance, my university chancellor received a letter from a viewer asking if he knew that his faculty member had so few qualifications that she said you could eat fruits and vegetables in the same meal. Still, we should make use of our nutrition knowledge to try to reach the most people. Morning television talk shows reach 5 to 10 million people, and a clear channel radio station may reach even more at night. Remember, though, that the more people you reach, the more possible trouble may await you—even the threat of lawsuits. Nevertheless, my advice is to become involved. The alternative is to let the quacks win. What are we doing right? Judith Dodd, former President of The American Dietetic Association (ADA) summed it up beautifully: “We are specially trained in translating nutrition science into practical food choices, and we've carried our message to community and school groups, worksites, hospitals” (40.Dodd JL Marketing Nutrition.Nutr Today. 1992; 27: 39Google Scholar). In her opening remarks to the 76th Annual Meeting of ADA, Susan Calvert Finn enumerated some of our activities in which we reach the public with nutrition information: the ADA's National Center for Nutrition and Dietetics offers food and nutrition information to the public 24 hours a day via a hotline; National Nutrition Month® enhances public knowledge about nutrition; ADA has worked with members of Congress, the FDA, and the US Department of Agriculture to bring about labeling reform; and a national network of close to 100 registered dietitians has been trained as media spokespersons. Clearly, we are doing the right things. Why, then, do so many people think they know more about nutrition than we do? Taxi drivers, even friends, tell me what to eat. Is there another profession in which experts receive so much unsolicited advice from laypersons? No one tells civil engineers how to build bridges. In what other profession does everyone know more than the expert about the subject matter? We have our work cut out for us. Eleanor Roosevelt said: “No one can make you feel inferior without your consent” (41.Peter LD Peter's Quotations, Ideas for Our Time. Bantam Books, New York, NY1977: 369Google Scholar). Are we being made to feel inferior? If so, what should we do about it? I used to say: “become a physician.” This was probably poor advice. Instead, we should ask physicians to cooperate with us and to acknowledge dietitians as part of the health professional team. My next bit of advice was to “go to law school so we can sue the quacks.” That was probably poor advice as well. A better suggestion might be to become more involved in changing the laws. We need to know the power structure and how to act within it. Are we, as dietitians and health professionals, any part of the problems? To find the answer we must look at what we tell the public. We need to keep the following key strategies in mind:•Keep advice simple to understand and implement. Look for example, at the advice “eat no more than 30% of calories from fat” from the perspective of the average consumer. What does that mean? How does a person find out whether he or she is following that advice? As any dietetics professional knows, first people have to know how many calories they eat per day, figure out what 30% of that is, then make some calculations to find out how many fat grams they are eating, and relate the answer to diet. Even the part of the American public that can figure out batting averages will have a hard time doing the arithmetic needed to calculate fat percentages.•Avoid contributing to the public's confusion by being too quick to laud the latest nutritional theory. In other words, we must think before we proclaim the final word on a nutrition topic.•Avoid speaking in nutrition buzzwords.•React continually to misinformation to combat quackery.•Keep the message positive. The public wants health professionals to agree on a set of clear, consistent, focused, and positive messages based on current knowledge. They do not want negative advice such as “cut down on.” The public wants a simple behavior that can be followed (42.Goldberg JP Nutrition and health communication: the message and the media over half a century.Nutr Rev. 1992; 50: 71-77Google Scholar).•Stay current with the latest literature. This is key if we are going to communicate with the public, patients, clients, and students. However, one study (43.Vickery CE Cotugna N Journal reading habits of dietitians.J Am Diet Assoc. 1992; 92: 1510-1512Google Scholar) showed that less than half of the dietitians surveyed read professional journals more than 1 hour per week. The excuse was there was not enough time. We have to make enough time to stay knowledgeable or we will end up turning over our profession to those with no professional training.•Avoid going against the tide. Tie your nutrition message to current lifestyle trends. For example, we must recognize that in today's fast-paced lifestyle, many people frequently eat out or have food sent in. People eat fast foods out of time constraints. It is pointless to advise consumers not to eat fast food; fast food is not going to go away. Instead, we need to teach consumers to make healthful choices when they eat out and teach them how to prepare healthful foods quickly at home. The other alternative is to work to change the fast-food industry.•Do not be an alarmist. If you constantly proclaim danger about food, people will soon believe that nothing is really dangerous. This is reflected in the polls. Concern about healthful eating habits has slipped since last year, and food products high in fat, sugar, and salt have made spectacular gains in the market.•Be aware of possible ethical conflicts. Speaking to the media will bring us to a wider audience. However, what few realize is that television programs, magazines, and newspapers do not pay you for an interview, although publications may pay you to write an article. Who is going to pay you to travel around the country or world speaking about healthful diets? Someone has to pay your expenses and/or speaking fees, unless you are independently wealthy. Are you, in fact, making a commercial for this product? Do you fully believe in what you are saying? Would you say the same thing if you were not being paid to speak? The ethics of this situation must be discussed.•Stop arguing among ourselves about subjects that have been discussed for years with no conclusion in sight. Stare (44.Stare FJ Combating misinformation—a continuing challenge for nutrition professionals.Nutr Today. 1992; 27: 43-46Google Scholar) reminds us to search the older literature, look at the history of nutrition, and stop wasting time reinventing the wheel.•Stay inside your area of expertise. Unless you are qualified as an exercise expert, do not tell clients or patients how to exercise. If we want nonqualified people to stay out of our field, we must do the same or be considered a quack in their field of expertise. The alternative is to become qualified as an exercise physiologist, trainer, or physical therapist.•Know your subject area. When we speak about nutrition to the public, to colleagues, and to other health professionals or when we consult, we need to be enthusiastic and knowledgeable. We need to be able to explain what is in the news. If you tell people that free radicals and antioxidants are too complex to explain, then you really do not understand the concepts yourself. It is impossible to do too much homework.•Be brief. Even an adult's attention span is short. You only have a short period of time to deliver your main message points.•When speaking to an audience, make sure you and your visuals can be seen and that you can be heard all over the room. We need to push for total nutrition education and soon. The nonprofessionals have already surrounded us. Powerful forces out there are using nuclear weapons against us while we are using smiling faces. Start somewhere. Write one letter. Give one speech. Write to one newspaper. We have knowledge, and knowledge is power. Every single one of us must use that power.