Disclosing Nutritional Information to Reduce Disease
The Nutrition Labeling and Education Act of 1990 (NLEA) required food processors to label products with amounts of key nutrients as a public health measure. Chronic diseases such as heart ailments, cancer, and diabetes were the largest causes of preventable deaths in the United States, killing more than 1.5 million people each year. Scientists agreed that the single most important factor in preventing and minimizing the effects of such diseases was improved diet. Before Congress acted, however, consumers had no way to assess the healthfulness of most packaged foods. Supporters of the law hoped that it would create new incentives for Americans to eat healthier foods and for manufacturers to market healthier products.
Consumer groups combined with organizations such as the American Cancer Society and the American Heart Association to promote nutritional labeling as a public health measure rather than simply a right-to-know cause. Entrepreneurial members of Congress, led by Representative Henry Waxman (D-Calif.) and Senator Howard Metzenbaum (D-Ohio), pressed for the new labeling law. The food industry supported disclosure both as preferable to conflicting state requirements and as a means to reap profits from marketing healthy products.
The new law required food processors to label in standardized formats amounts in each serving of total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, and total protein, in the context of amounts recommended for cons umption as part of a daily diet. Companies also had to list total calories and calories from fat in each serving. Serving sizes were standardized to conform to amounts customarily consumed. Products that were not labeled accurately and completely could be deemed misbranded by the federal Food and Drug Administration and removed from the market. In 1994, when the law took effect, interested shoppers could compare nutrients in virtually every can, bottle, or package of processed food for the first time. The law was appropriately heralded as the most important change in national food policy in fifty years.
However, Congress also gerrymandered the labeling requirement to satisfy powerful interests, exempting nearly half of consumers’ food purchases. Fast-food outlets, full-service restaurants, fresh meats and seafood, deli items, and dietary supplements all escaped labeling.
Nutritional labeling did improve over time – but only slowly and sporadically. Often labeling failed to keep pace with new science. Scientists had known since the 1970s that trans fatty acids were the most health-threatening fats, for example. The FDA, however, did not require their listing on food labels until 2006. Major food allergens, too, were not clearly labeled until 2006. And labels continued to group together all carbohydrates despite evidence that complex carbohydrates were healthier than simple carbohydrates. In a particularly serious limitation, the risks and benefits of dietary supplements remained largely undisclosed.
Disclosing Medical Mistakes to Reduce Deaths and Injuries
Despite an urgent call by the prestigious Institute of Medicine in 1999 for a new disclosure system to reduce medical mistakes in hospitals, federal moves to increase transparency have been slow and contentious, and state reporting requirements have proven difficult to sustain.