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Health Surveys

Most health professionals and health students believe GM foods are unsafe

Background:

Genetically modified (GM) foods and crops are a controversial subject. There is controversy in many regards including the safety of GM foods, whether the current regulations are sufficient, whether or not GM foods should be labeled, if people want to consume GM foods and if there should be a moratorium on GM foods and/or crops.

Purpose:

To determine the consensus of opinion among individual health professionals and health students, between the years 2009-2019, on safety, regulation, labeling and willingness to eat GM foods and their beliefs about a moratorium on GM foods.

Data Sources and Selection:

Electronic literature systematic search using Google Scholar and Google search engines.  Manual reference checks of all articles related to surveys of health professionals from around the world, with regards to their opinions on GM foods and crops.

Data Extraction:

25 relevant surveys of health professionals and health students were found for opinions about GM food safety between the years 2009 to 2019.  These surveys represented health professionals from 8 different countries.

11 relevant surveys of health professionals and health students were found for opinions about GM food labeling between the years 2009 to 2019.  These surveys represented health professionals from 4 different countries.

16 relevant surveys of health professionals and health students were found for opinions about willingness to consume GM food between the years 2009 to 2019.  These surveys represented health professionals from 6 different countries.

10 relevant surveys of health professionals and health students were found for opinions about support for GM food and crop production between the years 2009 to 2019. These surveys represented health professionals from 4 different countries.

4 relevant surveys of health professionals and health students were found, between the years 2009 to 2019, for opinions about the regulatory process or agencies that regulate GM foods and crops.  These surveys represented health professionals from 3 different countries.

Results:

In at least 92% of surveys about GM food safety the majority of health professionals and health students either believe GM foods have health risks, or are neutral or unsure about the safety of GM foods.

In 100% of surveys about GM food labeling the majority of health professionals and health students believe GM food products should be labeled.

In 87.5% of surveys about the willingness to consume  the majority of health professionals and health students were unwilling or unsure about consuming GM foods, or would choose non-GM foods over GM foods.

In at least 80% of surveys the majority of health professionals and health students either do not support GM foods and/or GM crop production in their respective countries, or are unsure.

In 100% of surveys the majority of health professionals and health students either do not believe the regulatory process is adequate for GM foods and/or crops or were unsure about the adequacy.

Conclusion:

The results of this review indicate that the common claim that there is a consensus among health professionals that GM foods are as safe and healthy as their conventional counterparts is not supported by the available evidence.  Based on the results of this systematic review a clear consensus amongst individual health professionals emerged.  The consensus among health experts is that GM foods currently on the market cannot presently be considered as safe as their conventional counterparts, either due to lack of evidence of safety, or because of evidence that at least some GM foods currently on the market may be unsafe compared to their conventional counterparts. Surveys indicated that health professionals and students surveyed do not generally support GM foods or production and are generally unwilling to consume, or unsure about consuming, GM foods.  Health professionals surveyed do, however, overwhelmingly support mandatory labeling of GM foods and better regulations for GM foods.  Further surveys of health professionals from around the world are necessary as the results of this systematic review only identified surveys of health professionals from 8 countries.

Introduction:

The AAAS is the largest general science group in the world, with over 120,000 members.  The AAAS consists of scientists and science students having backgrounds ranging from agriculture, biological, medical, chemistry, earth, engineering, math, computer, physics, astronomy, social, behavioral and other sciences (AAAS 1). In a 2014 survey of only AAAS members it was determined that 88% of the 3,748 members surveyed believed that GM foods were safe to consume (Funk 2015). In the original report, 50% of the scientists surveyed were placed in one category labeled according to their backgrounds as, “Agriculture, Biological or Medical Sciences”(Funk 2015).  In an elaboration of the original report, for some unknown reason, 50% of the scientists in this category were relabeled as, “Biomedical sciences”(Pew Research Center 2015).  Due to this discrepancy it is unclear if the 1,802 members listed as, “Biomedical sciences” in the elaborated report also include scientists with backgrounds in agriculture and biological sciences.  According to the elaborated report, of this “Biomedical sciences” group, 91% believed GMOs are generally safe to consume(Pew Research Center 2015). Other recent surveys, however, give different results such as a peer reviewed study which included a survey of Polish scientists from 2014-2015.  In this peer reviewed study it states, “In the present study, over 50% of polled Polish researchers were against the production and distribution of GM foods, contrary to the US where scientists largely consider these products as safe”(Rzymski 2016).

We, therefore, performed a systematic review of surveys of individuals in the fields of medicine or public health, and students in such fields, from around the world. The goal of our systematic review was to determine the state of opinion about: 1. the safety of GM foods, 2. the adequacy of GM food regulations, 3. the labeling of GM foods, 4. the willingness to consume GM foods compared to non-GM foods and 5. whether or not GM foods and/or crops should be produced.

Results:

See Supplementary Table Report 2

GM Food Safety

25 relevant surveys of health professionals were found for opinions about GM food safety between the years 2009 to 2019. These surveys represented health professionals from 8 different countries. In at least 92% of surveys about GM food safety the majority of health professionals and health students either believe GM foods have health risks, or are neutral or unsure about the safety of GM foods.(Supplementary Table Report 2)

GM food labeling

11 relevant surveys of health professionals were found for opinions about GM food labeling between the years 2009 to 2019. These surveys represented health professionals from 4 different countries. In 100% of surveys about GM food labeling the majority of health professionals and health students believe GM food products should be labeled.(Supplementary Table Report 2)

Willingness to consume GM food

16 relevant surveys of health professionals were found for opinions about willingness to consume GM food between the years 2009 to 2019. These surveys represented health professionals from 6 different countries. In 87.5% of surveys about the willingness to consume GM foods the majority of health professionals and health students were unwilling or unsure about consuming GM foods, or would choose non-GM foods over GM foods.(Supplementary Table Report 2)

Support for GM crop/food production

10 relevant surveys of health professionals were found for opinions about support for GM food and crop production between the years 2009 to 2019. These surveys represented health professionals from 4 different countries. In at least 80% of surveys the majority of health professionals and health students either do not support GM foods or GM crop production in their respective countries, or are unsure.(Supplementary Table Report 2)

Regulations of GMOs

4 relevant surveys of health professionals were found for opinions about the regulatory process or agencies that regulate GM foods and crops between the years 2009 to 2019.  These surveys represented health professionals from 3 different countries. In 100% of surveys the majority of health professionals and health students either do not believe the regulatory process is adequate for GM foods and crops, or were unsure about the adequacy. (Supplementary Table Report 2)

Discussion:

Health Practitioner Surveys GM Food Safety

Taken together, the surveys reviewed on GM foods and health risks indicate that health professionals and health students either believe GM foods have health risks, or are neutral or unsure about whether they have health risks.  This suggests that the claim that there is consensus amongst health professionals that GM foods are as safe and healthy as their non-GM counterparts is not supported by the available evidence.  Based on the results of this systematic review, however, a clear consensus amongst health groups and individual health professionals emerged. The consensus among health experts is that GM foods currently on the market cannot presently be considered as safe as their conventional counterparts. This is either due to lack of evidence of safety, or because of evidence that at least some GM foods currently on the market may be unsafe compared to their conventional counterparts.

The claim that there is consensus that GM foods are as safe and healthy as their non-GM counterparts has largely been based on a single survey of select AAAS members.(Funk 2015)  The survey of AAAS members, which reported that 88% of its respondents believe GMO food is safe, represents the greatest endorsement of this belief of any survey found.  The results of the survey of AAAS members is, therefore, not consistent with other surveys of individual health professionals. In at least 92% of surveys(23 of the 25) about GM food safety the majority of health professionals and health students either believe GM foods have health risks, or are neutral or unsure about the safety of GM foods.  In the 1 other survey 45% believed that GM foods had health risks and 45% believed that GM foods had benefits.(Ayande 2015)  It is unclear what the remainder of the respondents answered. If at least 6% answered that they were unsure if GM foods have health risks then none of the surveys would agree with the AAAS scientists and students surveyed.

In general, health professionals and students largely believed GM foods were unsafe for human consumption. This result is interesting because medical and public health groups largely stated they were unsure about the safety of GMOs(See Report 1). Names of individual health practitioners were kept private in the surveys, whereas those involved in statements made by medical and public health groups were often made public. This may indicate that health practitioners could be more likely to privately believe GMOs are unsafe, as compared to what is stated publicly. This could be caused by a fear of retaliation for expressing concern about GMOs, which some scientists and health professionals have stated that they have experienced. (Dewey 2017, Lotter, 2009; Glenna, 2015; Seralini, 2014)

Pew surveys of the general public in the U.S. consistently find around half or more of respondents believed GM foods were not safe to eat, or are unsure about the safety of GM foods.(Funk 2015, Pew Research Center 2016, Kennedy 2018) This indicates that the general public appears to have an opinion similar to health professionals in most surveys.  One possibility for the similarity is that the general public may trust the information coming from health professionals on GM foods.  The general public may then base their opinions on those of health professionals.  In a 2019 survey, for example, Americans were asked who they most trusted for information about which foods to eat or avoid.  Most respondents indicated they most trusted conversations with registered dietitians and nutritionists or personal healthcare professionals for this information.(Lewin-Zwerdling 2019) This is not surprising, because health professionals are the experts on food and health issues.  In the same survey consumers indicated the sources they would look for information about GM foods are health websites and scientific studies(Lewin-Zwerdling 2019)  The opinion of Americans surveyed about GM foods is consistent with the results of our systematic review which indicate most health groups believe there is not enough evidence that GM foods currently on the market are safe.(Report 1)  It is also consistent with the result of our systematic review which indicates most animal feeding studies using the popular GM soy GTS 40-3-2 suggest adverse effects or biomarkers indicative of adverse effects.(Report 3)

Health Practitioner Surveys Willingness to Consume GM Food

It would be expected that American health professionals would be much less likely to purchase non-GMO foods than the general public if they agreed with the AAAS members surveyed. In a paper using Nielsen Homescan data from 2016, however, it was observed that health professionals were no less likely to purchase non-GMO milk or eggs than other consumers.(Björkegren 2018)  This is consistent with the results of our systematic review of health professionals surveyed.  The results of which indicate in 87.5% of surveys the majority of health professionals and health students were unwilling or unsure about consuming GM foods, or would choose non-GM foods over GM foods.

Health Practitioner Surveys GMO Labeling

On all surveys with questions pertaining to GM food labels, the majority of health professionals and health students indicated their support for the labeling of GM foods.  This is consistent with the position statements, reports and other documents from health groups around the world reviewed in Report 1 which indicated about 93.7% believed GM food labeling should be mandatory.

Health Practitioner Surveys GM Food/Crop Moratorium

In 8 out of 10, or at least 80%, of surveys the majority of health professionals and health students either do not support GM foods or GM crop production in their respective countries, or are unsure.  In 1 survey of medical students, however, 48% were against the production and distribution of GM foods and no data was provided for the remainder of respondents.(Ryzmski 2016)  If even 3% answered that they were unsure about the production and distribution of GM foods then this would leave only one survey in favor of GM food or crop production. This one notable exception was a survey by the United Soybean Board which indicated that 61% of dietitians surveyed view biotechnology as a positive method for food production.(United Soybean Board 2012)  Biotechnology can include any technology that uses biological systems, organisms, or derivatives.  It is unclear what definition of biotechnology the participants surveyed were given and if this survey applies specifically to GM foods.  The United Soybean Board also has a conflict of interest as they are involved with promoting GM soy.  It is, therefore, unclear if any surveys supported GM food or crop production. These results are fairly consistent with the position statements, reports and other documents from medical and public health groups around the world reviewed in Report 1.  The results of which indicated about 63.2% believed there should be a moratorium on all or some GMOs.

Health Practitioner Surveys Regulation of GM Food/Crops

Surveys of health professionals and students regarding whether or not current regulations on GMOs were adequate were more limited than the other topics included in our review, with only 4 total surveys. Of these 4 surveys, however, the majority of health professionals and students surveyed either do not believe the regulatory process is adequate for GM foods and crops or were unsure about the adequacy.  This result is consistent with the position statements, reports and other documents from medical and public health groups around the world reviewed in Report 1.  The results of which indicated 77.4% believed the current regulatory process for GMOs is insufficient. It is also consistent with recent reviews which suggest the regulations for GM foods are inadequate. (Miyazaki 2019, Hilbeck 2020)

Survey Not Included

It should be noted that our search identified 1 survey which met the criteria of our systematic review, but was not included in our review.(Zajac 2012)  We were unable to include this survey, because we could not get access to the full text of the survey and we were unable to get specific data from the abstract of this survey.  Based on the abstract, however, it would appear the results of this survey are consistent with the results of the majority of other surveys used in our systematic review.  This suggests  the results would, therefore, not have been substantially changed if it were included in our systematic review.

Health Practitioner Opinions Education, Experience and Knowledge

Some evidence suggests that beliefs about GM foods may be shaped by health professionals’ health education, and experience, which may lead them to better recognize the risk of GM foods (Savas 2014, Kaya 2016). Some specific information given to health professionals and food safety experts, however, may make them slightly less concerned(McDaniels 2017, Stadler 1998), or slightly more concerned(Donnelly 2014) about the safety of GM foods. In one survey included in the present review, dietitians with the greatest knowledge of GMOs were also the most likely to oppose using GMOs. (Vogliano 2012) This is in contrast with another survey which concluded those who are more knowledgeable about GMOs had a more positive attitude towards GM food.(Ebuehi 2012) The knowledge questions asked by Ebuehi, however, were largely misleading.  For example, respondents were given statements such as, “Genetic modification (GM) increases product yield” and, “GM organisms grow faster”.  There is evidence that GTS 40-3-2, a type of GM soy, has lower yields compared to non-GM soy.(Elmore 2001, Gordon 2007, Quarles 2017) Yet, if those who were surveyed responded “No” or “I don’t know” to these questions they were marked as being incorrect.  It is also not likely that knowledge of GM farming practices, such as which countries grow the most GM crops, that were asked on some surveys would translate to knowledge about GM food health risks.  For example, we would not expect a physician’s knowledge about which countries grow the most tobacco to reflect their knowledge on the harms from smoking or chewing tobacco.  Further surveys should be done to gauge if a health professional’s knowledge about GMOs is correlated with attitude about GM foods.  Questions should be similar to those used by Vogliano 2012 instead of farming based questions.

Vast Difference Between AAAS Members and Health Practitioners

Possible explanations for the vast difference between AAAS scientists/students and health professionals/students from around the world may be at least partly due to differences in the response rate. The AAAS member survey had an 18.8% response rate (3,748/19,984) which is the lowest of all of the reported response rates for the other surveys of health professionals found. A low response rate may indicate non-response bias, i.e., mostly those with a strong opinion filled out the survey, which may distort the result.  Evidence to support this comes from the fact that nearly half of the scientists and science students who filled out the survey were labeled biomedical scientists(Pew Research Center 2015). At the time the Pew survey was administered the California Biomedical Research Association had the following statement on their website:

“The use of genetically modified organisms represents an enormous advance in the science of biological and medical research, and GMOs are playing an increasingly important role in the discovery and development of new smedicines .”(California Biomedical Research Association Undated)

The use of bold writing to emphasize the word, “enormous” indicates that the California Biomedical Research Association does indeed have a strong opinion.  Since California is the most populous state in the U.S. it is possible many of the biomedical scientists surveyed were from California. The California Biomedical Research Association’s website at the time also stated:

“Wide-sweeping legislation, intended for agricultural crops, is predicated on fear and inaccurate claims, and threatens to ban the presence and use of all GMOs. Such a widespread ban essentially puts significant medical advances at risk, is detrimental to the discovery of new therapies, treatments, and cures, and threatens to reverse progress made over the last several decades.” (California Biomedical Research Association Undated)

The California Biomedical Research Association appears fearful that bans on agricultural production of GMOs, as was occurring in some California counties, would cause a ban on GMOs used in biomedical research.  This fear was unfounded as the legislation regarding agricultural bans specifically exempted GMOs used in biomedical research.(Smart Voter 2004)  The California Biomedical Research Association appears to have realized this fear was unfounded as their 2018 statement no longer contains the above statement or any similar statement.(California Biomedical Research Association 2018)  This may indicate that the American biomedical scientists that took the Pew survey believed, as the California Biomedical Research Association did, that the concern about GMOs in agriculture would harm their own research.  They may have, therefore,  based their opinion on their own unfounded fear rather than the scientific evidence, or lack thereof, on the safety of GM foods.

Another possibility for the substantial difference may be the field of biomedicine itself.  In 1 other survey of biomedicine students, 73% surveyed supported the consumption of GM foods.(Quesada 2014)  According to the same survey, however, only 57% of biomedicine students used biotechnology concepts in their courses.  In comparison, 100% of nursing students and 67% of nutrition students used biotechnology concepts in their courses and were less supportive of the consumption of GM foods.(Quesada 2014)

Another possibility for the dramatic difference between the opinion of the AAAS scientists surveyed and all other surveys of health experts is the questionnaire itself.  It is unclear if the AAAS members surveyed were given a definition of “genetically modified” and if they understood that most GM foods are sprayed with or manufacture pesticides.(United States Department of Agriculture Economic Research Service 2015)  It appears unlikely that the AAAS members were aware of this as their opinions on the safety of GM foods and the safety of consuming foods grown with pesticides differ.(GM Watch 2015)  Another problem with the survey question is it only allowed for 2 possible answers.  Those surveyed were unable to mark, “unsure” for example, and it was unclear how certain they were about their answer.  If the options would have included, for example, “strongly agree”, “agree” and “somewhat agree” this would have told us more about how confident they were with their answer.  If most of the AAAS scientists only somewhat agreed then this would have put them closer to the opinion expressed in the majority of surveys of health professionals. Such a scenario would have called into doubt the claim of a consensus that GM foods currently on the market are safe rather than be used to support it.

Another possibility is the demographic of the AAAS members surveyed. The AAAS members surveyed were all Americans, and most were white (83%) and male (71%). According to a Pew survey of the general public, white male Americans were more likely to believe GMO foods were safe compared to other demographics (Funk 2015).  In another survey, educated white male Americans were more likely to defer to a scientific authority when they had low levels of information on GM foods (Brossard 2007). The AAAS member survey did not attempt to measure knowledge on GM foods. However, since this survey was of AAAS members, one scientific authority they would be likely to defer to, if their level of knowledge was low, would be the AAAS Board of Director’s statement. The AAAS Board of Directors’ statement contains some of the strongest language of any position statement, stating, “every other respected organization” agrees that GM foods are safe.(AAAS Board)

Low response rate, poor questioning, demographic and deference to the AAAS Board may explain the vast difference between the AAAS members surveyed and surveys of health professionals from around the world.

Surveys of medical and public health professionals can only provide a snapshot of the opinion at a given time.  As opinions are dynamic and not static it is not possible to say an opinion at a given time extends beyond that time period or is still a current opinion. The same could be said, however, about the 2014 AAAS member survey, since new evidence may change the opinions of members surveyed. For example, many GM crops, such as Roundup Ready soy, are modified to be tolerant of the herbicide glyphosate when directly sprayed. Studies suggest GM soy has higher levels of glyphosate residue compared to non-GM soy (Bohn 2013, Bohm 2008). In 2015, the International Agency for Research on Cancer declared that glyphosate is a probable human carcinogen(Fritschi 2015). Such a report might have altered the opinion of those surveyed. In order to consider if a consensus has existed at any given time, however, a review of surveys still provides important information.

Conclusion:

The claim that there is a consensus that GM foods currently on the market are as safe and healthy as their conventional counterparts has been largely based on a single survey of AAAS scientists.  Taken together, surveys of medical and public health professionals and students, the experts on human health, do not support this claim. This systematic review of health professional surveys does, however, indicate a consensus exists on the safety of GM food. That consensus among health experts is that GM foods currently on the market cannot presently be considered as safe as their conventional counterparts. This is either due to lack of evidence of safety, or because of evidence that at least some GM foods currently on the market may be unsafe to consume compared to their conventional counterparts. Health professionals surveyed indicated that they do not generally support GM foods or production and are generally unwilling to consume, or unsure about consuming, GM foods.  Health professionals surveyed do, however, overwhelmingly support mandatory labeling of GM foods and better regulations for GM foods.  Further surveys of health professionals from around the world are necessary as the results of this systematic search only identified surveys of health professionals from 8 countries.

Method:

We performed a systematic review for the following questions:

Do individual health practitioners believe genetically modified foods on the market are safe or nearly safe, there is not enough evidence to determine if genetically modified foods on the market are safe (neutral, unsure), or there is enough evidence to determine that genetically engineered foods on the market are slightly, moderately or very unsafe?

Do individual health practitioners believe current regulations for genetically modified foods are sufficient (excluding labeling), current regulations for genetically modified foods are not sufficient(excluding labeling) or current regulations for genetically modified foods are too restrictive(excluding labeling)?

Do individual health practitioners believe labeling of genetically modified ingredients should be mandatory, unsure or neutral about labeling of genetically modified ingredients, labeling of genetically modified ingredients should only occur if the Ingredient is not substantially equivalent?

Do individual health practitioners believe there should be a moratorium on all or some GM plants or animals, there should not be a moratorium on all or some GM plants or animals or unsure about a moratorium on all or some GM plants or animals?

Do individual health practitioners believe they are willing to consume GM foods, they are unwilling to consume GM foods, they are unsure if they are willing to consume GM foods, when compared to non-GM foods?

Criteria for health professional surveys:

We included health professionals and health students. All surveys published before 2009 and after 2019 were excluded. Focus groups were excluded. Surveys that did not indicate the year surveyed, but were published between 2009 and 2019 were included. Only surveys which presented data in percentage form were included. Surveys which presented data in graded scales, such as Likert, and did not also include a percentage were excluded. Survey questions which were not specific to the focused questions, and/or included other uses of genetic modification besides food and agricultural use, were excluded.

Rationale for health professionals surveys: To mimic the Pew/AAAS survey, eligibility “includes those with B.S., degrees in progress, and unclear responses.” Focus groups are not confidential, therefore, a participant may not share their true beliefs if it conflicts with the beliefs of their institution,  or if it conflicts with the beliefs of other participants. Graded scales were eliminated due to heterogeneity of data.

Google Scholar and Google searches were performed using the following terms:

“genetically modified foods” “survey” “doctors”

“genetically modified foods” “survey” “physicians”

“genetically modified foods” “survey” “nurses”

“genetically modified foods” “survey” “dietitians”

“genetically modified foods” “survey” “nutritionists”

All hits were examined within the first 10 pages, including articles, blogs as well as conference papers and peer reviewed studies. No language restrictions were applied. In cases where relevant references were mentioned those references were searched for using Google and Google Scholar. In cases where links to websites were provided but were no longer working, Internet Archive was used.

Criteria for Surveys:

When percentage was given and/or the number of individuals surveyed was given:

Responses were categorized by Yes, No, Don’t Know/Neutral and the number of individuals that made such a response were entered into those categories. Data were then pooled by number of individuals in each category. The total number surveyed allowed for percent of each group to be determined. If data for one category was complete, but data for another category was missing, the complete data was still used, but the missing data was left out.

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