Sometimes we wonder what's in the minds of our civil servants, those faceless bureaucrats who often affect our lives, but whom we know only as The Federal Government. Food section reporter Carole Sugarman talked to Sanford A. Miller, director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition, which is responsible for overseeing the safety of the nation's food supply, ranging from regulation of food additives to food labels.
As its director, Miller is no ordinary federal employe. Both inside the agency and out, he is known as a connoisseur, a renaissance man and a colorful raconteur. He studies the dynamics of food, culture and cooking as much as the interactions of food, politics and science. At 53, Miller has been at the FDA since 1978. Prior to coming to the FDA, he was a professor of nutritional biochemistry at the Massachusetts Institute of Technology, where he is presently on leave.
Q: What would you do as a private citizen when it comes to food safety if you weren't in the government and if you didn't have a scientific background?
A: I think the first thing I'd do is make myself knowledgeable about the issues. And I mean not to accept without question any negative or critical reports that people are giving about the FDA. Look at the issues themselves.
You don't need a scientific background. All you need is common sense. If you think about it for a minute, there are some people who believe that if you find one sample that exceeds the tolerance for a pesticide, that's going to cause cancer when you eat it. And the fact of the matter is, the tolerances are set at a level which is not only safe but safe if you consume that level your entire lifetime. So that the fact that you have an occasional one that goes above it is meaningless.
All right, so you get a report from an organization that says, "Ah ha, we found traces of this pesticide in food. Why isn't the FDA doing its job?" It doesn't take much common sense to realize that of course you're going to find traces of pesticide in occasional products. The more important thing is what is the pattern over a period of time.
Q: But how do you determine how safe is safe enough?
A: That of course is the big debate. What you have to come to is the basic understanding that nothing is without risk. There isn't anything in this world, including me talking on the phone to you right now, as you well know, that's without risk. Even the most pleasurable thing in the world -- ranging from sex to watching a good movie, or eating -- is not without its risk.
What you have to do is try to get some handle on the relative risks that might be involved. Most of us deal with a kind of intuitive perceptual risk, which isn't very useful because we tend to overestimate the risks of the things we don't know about and underestimate the risks we're familiar with. But if I told you that the chances of anything, anything in food causing your death -- even accumulation over a lifetime -- was fractional compared to the risks of driving your automobile, you wouldn't buy that. But yet that's a fact.
Q: But doesn't part of it have to do with who's in control?
A: You know, there's a thing in America which is one of things which makes us, frankly I think, such a great democracy. We don't trust government. By definition, government, at very best, is a friendly adversary. Most of us come from backgrounds from other countries, where government was once a more active enemy. And so this whole country was founded by people who distrusted government. The result of this is that that same philosophy still exists today. People simply refuse to believe that the government is trying to do something on their side, irrespective of what it does.
Q: Do you think there is any way to change that, or is that just the way it should be?
A: That's where we are, and I think the regulatory agencies accept that. I think what we don't accept is somehow the idea that somehow or other what we do is the result of chicanery or dishonesty or of being bought by somebody. There's no decision that this bureau can make that is not controversial and which people like. We are accused as often as being on the side of industry as we are of being controlled by the consumer people. Each one thinks we're in the pocket of the other. If you look at our record, we've approved some things that the consumers don't want us to approve, we don't regulate some things that the industry wants us to regulate and we just do whatever we think is the most objective way of handling it. But the end result of all this is constant criticism, constant beating on the head, which after a while wears people out. What happens is that we lose good people and find it very difficult to get good people to come into this kind of environment.
Q: So, you being in that position, why do you do it?
A: Remember, I came into it late in life. I spent 20 some-odd years teaching in a university and among the things I tried to get across to my students is that as teachers at a university and as scientists, among other things, we had not only a personal responsibility or an abstract responsibility to something called increasing knowledge, but a responsiblity to the public.
When I was asked to come down here by Don Kennedy then FDA commissioner in 1978, my students then turned to me and said, "Now put up or shut up." And they were right. I told them I would come and I came for two years. I've been here for six. It is a man-killing or a woman-killing job to every day have to make a decision which you know consciously is going to effect the health of 240 million people. And this wears on you for awhile and so people in this job don't last very long. I do not expect to retire in this job.
Q: How does it your job make you feel from day to day? Is it pressure, is it frustration, is it stress? What is it?
A: It's everything. It's pressure, frustration, stress, worry, concern. Because, remember, the easiest thing to do is to say "no" to everything. But if we said that, then we might as well close up shop and we'd all die of starvation. I mean, let's face it, you can't grow the food you need, or run steers or grow fish on the 30th floor of a condominium. Therefore you need a food industry.
Q: What foods do you avoid?
A: Oh, I don't think there's very much. At home, we tend to eat a varied diet within limitations of a very busy family. I think we try to reduce our fat intake and there are lots of reasons for that. But there are very, very few foods that we will not eat. We don't eat a heck of a lot of candy bars, but that's just moderation. That's not to say we don't eat them.
Q: How many cups of coffee do you drink a day?
A: I drink a fair amount, maybe six or seven cups of coffee a day, but then I'm not pregnant or an adolescent. On the other hand, my daughters I've talked into keeping some restriction on their intake to less than four cups a day.
Q: How about soft drinks?
A: We drink soft drinks. Again, not a heck of a lot. I suppose when I'm on a diet, I drink more than when I'm not.
Q: Are you on a diet?
A: Almost always.
Q: Is it hard to practice what you preach?
A: Oh sure, of course. That's the reality of life. It's very hard to deal with those kinds of issues, unless you start out with them as a very young child. We're the products of our parents, and for most cases, it can be useful. From the kind of background I came from, it didn't help me a hell of a lot in terms of weight control.
Q: What do you think the American public misunderstands the most when it comes to the FDA's role in food regulation?
A: I think they believe we have a lot more power than we do. And they believe we can act by fiat, which we don't. Everything we do has to be operated in the openness of public participation. Every regulation we do has to be noted and commented. We are constantly under surveillance, not only by Congress, but the courts and the newspapers and everybody else. Every action we take is examined with a fine magnifying glass. That just takes longer. That means that the process is very slow. We must have all of our chips in order to take any action. We must be prepared to deal with litigation on every issue, criticism from the press on every issue, and the result is that it takes one hell of a long time.
Now people say, "why does it take you so long to act?" The choice they have to make is, do they want an open participatory kind of regulation or do they want the kind that virtually every other country in the world has? Regulators operate by fiat, you have no recourse.
Q: What do you think falls through the cracks at FDA?
A: I think economic issues. Issues concerning labeling and claims. And the reason -- that's almost purposeful -- is the question of resources. Given the choice between an economic issue and a health issue, we'll put our money on the health issue.
Q: How would you explain the fact that the FDA has taken no action on color additives?
A: That's an issue I can't talk about for a lot of reasons. For one thing, we're in litigation on that issue. The decision process now is at a point where it's not even in the FDA's hands.
Q: How about regulatory action on restricting the use of sulfites? Why hasn't the FDA done anything about that?
A: The fact is that we did. If you've been through the problem that we faced with that, you'd realize that the problem had to do with a segment of the population. The bulk of the population by far has no problem with sulfites.
The fact of the matter is, there are literally hundreds if not thousands of substances to which people are exposed to, and indeed every year there are people who die, many people who die because they are exposed to something to which they're sensitive to.
Q: Do you think that sulfites should not be banned?
A: No, let me just try to finish the point. Traditionally, our way to approach the problem is through labeling. People read a label and see it's there. The problem with sulfites is that in most situations it's applied as an aerosol in a restaurant situation. That's the place where labeling is probably least effective. Having said all that, you also have to understand that we don't control restaurants. The state controls them. Our approach was get the states to do the job here because that's where they operate. We don't have authority or people to do this work. And that's not been overly successful. So we've tried several other things using our more usual activities. We've put together a proposal concerning labeling, which is now being reviewed, and there are some other proposals as well, but those take a long time, as I've told you.
Q: Do you think irradiated foods should be labeled?
A: Yes, I personally do. The department may have another view on this, and there actually are some good reasons why you shouldn't have to do it. Why should you have to label irradiated foods when you don't have to label heat-processed foods or frozen foods? My own feelings are that it should be labeled, and when it's all said and done, I think it will be.
Q: What do you think is the major nutritional problem of the American public? What FDA policies are being or should be adopted that could address those issues?
A: I think obesity is, without question. But I think the other part of it is that the main nutrition problem with the American public is the lack of information. I think that our attempts to provide information in several different forms, plus working with Giant supermarket with shelf labeling and working with the department on educational things, will correct that with time. And people will be able to make appropriate decisions, so that this dietary pattern concept -- that certain diseases such as cancers or coronary heart disease is a function of a pattern of the diet, not any particular thing in the diet -- could be exploited so that people will have enough information to make appropriate dietary choices.
There's another point here. One of the important things that needs to be done -- and will be done in the next five to 10 years -- is that we've got to link agricultural policy and nutrition policy and health policy in this country. And I think that's coming. That means that farmers will be rewarded, not on the basis of just producing product, but by producing products that have certain health characteristics.
Q: Could you give me some examples?
A: One is dairy products. We should be paying for dairy products not on the basis of butterfat content, but on the basis of solid protein content. We ought to be developing strains of beef cattle that have considerably less fat on the carcass, yet at the same time offer flavor. We could develop strains of vegetable products that have better patterns of fatty acids, higher protein content. Productivity may be lower, but what comes out is nutritionally better and people will be willing to pay a premium for it.
Q: About the health claim issue. I know that the FDA has been cautious in its policy about health claims on food labels and that the FTC has applauded health claims on advertisements such as the recent All Bran ad that claims high-fiber foods can help prevent cancer. What do you think of the FTC's policy?
A: I don't want to comment on the FTC's policy, except to say one thing. Often what appears to be fundamental differences between agencies is really differences in the laws, differences in the dimensions of the laws, the limits of the laws, and differences in the kind of things we regulate. We're concerned with the label itself. There, there's a tight connection between what people believe of an individual product and the message on it.
Q: You don't think people make that connection in an ad?
A: The ad can be written in such a way that doesn't necessarily make it the connection . Plus, our law requires us to be very, very rigorous in our review of the data under which a claim is made. FTC's law doesn't read that way. They're susceptible to litigation if they try to be rigorous in that regard. I don't think there's a real conflict here.
Q: Do you think that FDA's voluntary sodium labeling program has been adequate, given the fact that only 50 percent of foods contain such labeling?
A: Sure, what it means is that virtually every product category has some foods that are sodium labeled.
Q: So how do people use that?
A: To compare one product to the other. If the data isn't there, then I think it's up to the public to say, 'Okay, I'm not going to buy it.' The public has got to play a role in this. We've got to get out of this business of the public as a passive component of the process. Irrespective of regulations, the public has got to express what they want in an active way by not buying products that aren't sodium labeled.
Q: So you think that's the public's job as opposed to the manufacturer's job?
A: I think it's the manufacturer's responsibility to do it. I think it's very difficult to force them to do everything you want them to. Maybe you can get them to do sodium, but what about the other things you want them to do? I believe that the agency, working with the public on these things, can get the industry to do any damn thing we want them to do. And that's a fact. But the public has to be active.
Q: FDA's other concern in this area has been reduction of sodium in products. According to a recent study, the number of product lines with lowered sodium content has been few.
A: That's not altogether true. There is a considerable effort in this area.
Q: I'm referring to the Center for Science in the Public Interest's recent survey that concluded that the salt content of most processed foods has not changed significantly over the last year .
A: What do you want in a space of just a few years? You don't reformulate all at once. People won't buy your products. If they took all the sodium out of the soups that CSPI would like, people wouldn't buy the soup. Like it or not, that's a reality. So what you do is slowly reduce the amount of sodium in your product. You keep on going down and down. As people get used to one level, you go a little lower until you've reached a resistence point. And I think that's what is happening. I think there are a lot of products that have lower sodium, but they're not much lower at this stage. I think they'll continue down as long as the public keeps demanding lower sodium products.
Q: How would you characterize the change in emphasis at the FDA since you've been there?
A: Well, that's hard to say. The center is continually moving in the direction of making sure our science is the best we have, the information is the best we have, being most efficient in what we do. Providing the best advice we know how. But there are other changes.
Q: How do you perceive those?
A: I don't know. I don't think that's an area I really want to talk about. I think it's inappropriate for me to talk about. Wait until I leave the agency.
Q: So when do you plan to leave?
A: Well, not within the next six months.